title: Long-term and 'patient-reported' outcomes of total esophagogastric dissociation versus laparoscopic fundoplication for gastroesophageal reflux disease in the severely neurodisabled child.
abstract: OBJECTIVE
  Fundoplication has high failure rates in neurodisability: esophagogastric dissociation (TOGD) has been proposed as an alternative. This study aimed to compare the long-term and 'patient-reported' outcomes of TOGD and laparoscopic fundoplication (LapFundo).
  
  
  METHODS
  Matched cohort comparison comprises (i) retrospective analysis from a prospective database and (ii) carer questionnaire survey of symptoms and quality of life (CP-QoL-Child). Children were included if they had severe neurodisability (Gross Motor Function Classification System five) and spasticity.
  
  
  RESULTS
  Groups were similar in terms of previous surgery and comorbidities. The TOGD group was younger (22 vs. 31.5months, p=0.038) with more females (18/23 vs. 11/24, p=0.036). TOGD was more likely to require intensive care: operative time, length of stay and time to full feeds were all longer (p<0.0001). Median follow-up was 6.3 and 5.8years. Rates of complications were comparable. Symptom recurrence (5/24 vs. 1/23, p=0.34) and use of acid-reducing medication (13/24 vs. 4/23, p=0.035) were higher for LapFundo. Carer-reported symptoms and QoL were similar.
  
  
  CONCLUSIONS
  TOGD had similar efficacy to LapFundo (with suggestion of lower failure), with comparable morbidity and carer-reported outcomes. However, TOGD was more 'invasive,' requiring longer periods of rehabilitation. Families should be offered both procedures as part of comprehensive preoperative counseling.
authors.affiliation: Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK. Electronic address: nicklansdale@me.com.
authors.forename: Nick
authors.initials: N
authors.lastname: Lansdale
authors.affiliation: School of Medicine, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: McNiff
authors.affiliation: Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
authors.forename: James
authors.initials: J
authors.lastname: Morecroft
authors.affiliation: Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kauffmann
authors.affiliation: Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
authors.forename: Antonino
authors.initials: A
authors.lastname: Morabito
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000379:methods*; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D061646:Operative Time; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Cerebral palsy; Child; Fundoplication; Gastroesophageal reflux; Total esophagogastric dissociation