title: Total esophagogastric dissociation: single center experience.
abstract: Fundoplication fails in approximately 20% of children with severe neurodisability. We aimed to evaluate total esophagogastric dissociation (TOGD) as a primary procedure and as a ‘rescue’ procedure for severely neurologically impaired children with significant swallowing discoordination and gastroesophageal reflux disease.
  
  
  
  Casenotes of 40 children with severe neurodisability who underwent TOGD between 2005 and 2015 were retrospectively reviewed. Of these, 33 were primary procedures and 7 were ‘rescue’ procedures following failed fundoplication.
  
  
  
  Median age at surgery was 3 years 7 months (range 1 month to 13 years 11 months). Preoperatively, all children had symptoms of regurgitation, retching or vomiting and 70% of children had an unsafe swallow. There were 5 early complications related to surgery in 4 children requiring surgical intervention. One child died following relaparotomy for esophagojejunal anastomotic breakdown because of multiorgan failure. Gastrostomy feeding was established by a median of 6 days (range 2 to 25 days) and median hospital stay was 10 days (range 4 to 280 days). There were 5 late complications. Median follow-up was 13 months (range 1 month to 8 years 4 months). All children have had resolution of gastroesophageal reflux. Thirteen percent of children experience bloating or pain on feeding and 26% of children experience retching unrelated to gastroesophageal reflux. There were 8 late deaths unrelated to surgery.
  
  
  
  TOGD should be considered as a primary and definitive procedure in selected severely neurodisabled children who are at higher risk of failure of fundoplication, recurrent aspiration and a reduced quality of life.
authors.affiliation: Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom.
authors.forename: Sumita
authors.initials: S
authors.lastname: Chhabra
authors.affiliation: Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom.
authors.forename: Anca-Mihaela
authors.initials: AM
authors.lastname: Nedea
authors.affiliation: Department of Paediatrics, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kauffman
authors.affiliation: Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom. Electronic address: Antonino.morabito@cmft.nhs.uk.
authors.forename: Antonino
authors.initials: A
authors.lastname: Morabito
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D009422:Nervous System Diseases / Q000150:complications; D011788:Quality of Life; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*
keywords: Esophagogastric dissociation; Gastroesophageal reflux; Severe neurological impairment