title: Total esophagogastric dissociation: 10 years' review.
abstract: OBJECTIVE
  Neurologically impaired children run a 12% to 45% risk of recurrent gastroesophageal reflux (GER) after fundoplication. Elimination of the reflux by "rescue" total esophagogastric dissociation (TEGD) encouraged us to use it also as a "primary" form of antireflux surgery in this group of patients.
  
  
  METHODS
  Twenty-six (14 male, 12 female) patients underwent TEGD between 1994 and 2004, of which 16 were primary and 10 were rescue procedures for failed fundoplication.
  
  
  RESULTS
  There was no operative mortality and postoperative complications were limited to one subphrenic collection, one esophagojejunal dehiscence, and one small bowel hernia beneath the jejunal Roux loop. Gastrostomy feeding was usually established by 3 to 5 days and the mean hospital stay was 10.2 days (range, 6-18 days). At follow-up of 7 months to 11 years, there was no recurrence of GER. Four late deaths were unrelated to the surgery. The children's nutritional status improved with the mean weight standard deviation score showing a statistically significant increase from -2.63 preoperatively to -0.96 postoperatively (Wilcoxon's signed rank P value < or =.005).
  
  
  CONCLUSIONS
  Total esophagogastric dissociation is a safe definitive solution for GER because it eliminates all risk of recurrent reflux. We therefore feel that TEGD can be used as a primary treatment of choice for severely neurologically impaired patients who are experiencing GER and are completely dependant on tube feeds.
authors: Department of Paediatric Surgery, Central Manchester and Manchester Children's University Hospitals, Manchester, M27 4HA, UK. antonino.morabito@cmmc.nhs.uk
authors: Antonio
authors: A
authors: Morabito
authors: Anupam
authors: A
authors: Lall
authors: R
authors: R
authors: Lo Piccolo
authors: Helen
authors: H
authors: McCarthy
authors: Lisa
authors: L
authors: Kauffmann
authors: Shiban
authors: S
authors: Ahmed
authors: Adrian
authors: A
authors: Bianchi