title: Esophagogastric dissociation reduces the re-operation rate for persistent gastroesophageal reflux in severely neurologically impaired children.
abstract: OBJECTIVE
  In this study we want to demonstrate the effectiveness of the esophagogastric dissociation as a first level operation in treatment of the gastroesophageal reflux in severe neurologically impaired children, in term of a reduction of reoperation rate.
  
  
  METHODS
  We divided patients operated from 1998 to 2005 in a group A, composed by children treated with fundoplication, and in a group AR, composed by the patients of group A who had a recurrence of reflux and that was treated with esophagogastric dissociation. Patients operated from 2005 to 2013 were selected on the basis of the severity of the neurological impairment and were divided in a group B, treated with fundoplication, and in a group C of more severe impaired children, treated with esophagogastric dissociation. Data regarding the complications of the A and C groups were analyzed with Fisher's test.
  
  
  RESULTS
  We evaluated 63 patients: 34 (54%) in group A, 11 in group AR, 15 (23.6%) in group B, 14 (22.4%) in group C. The Fisher's test showed a non significant difference with a p value of 0.2.
  
  
  CONCLUSIONS
  Despite of statistic result we believe that TOGD is a useful procedure as the first choice of surgical management in severe neurological impaired children affected by gastroesophageal reflux.
authors.affiliation: Department of Pediatric Surgery, University of Siena, Siena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Molinaro
authors.forename: Edoardo
authors.initials: E
authors.lastname: Bindi
authors.forename: E
authors.initials: E
authors.lastname: Cerchia
authors.forename: R
authors.initials: R
authors.lastname: Angotti
authors.forename: F
authors.initials: F
authors.lastname: Mariscoli
authors.forename: M
authors.initials: M
authors.lastname: Messina
mesh_terms: D000293:Adolescent; D002648:Child; D004947:Esophagus / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D007558:Italy; D008297:Male; D009422:Nervous System Diseases / Q000150:complications*; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome