Article Text

TOTAL OESOPHAGOGASTRIC DISSOCIATION IN THE TREATMENT OF GASTROESOPHAGEAL REFLUX IN NEUROLOGICALLY IMPAIRED CHILDREN
  1. L Kauffmann1,
  2. A Morabito1
  1. 1Department of Paediatric Surgery, Royal Manchester Children’s Hospital, Manchester, UK

Abstract

Objective Gastroesophageal reflux disease (GORD) is common in children with neurological impairment. Medical treatment is often ineffective and surgery may be advocated. The recent diffusion of laparoscopic surgery has reinforced the wide acceptance of fundoplication as the gold standard procedure in the paediatric population. However, the rate of re-operation is four times that in neurologically normal children. Total oesophagogastric dissociation (TOGD) is an alternative approach that has been successfully used to manage potentially life-threatening GORD. The objective of this paper is to analyse the effect of TOGD in the management of GORD in neurologically impaired children.

Methods All neurologically impaired children who underwent TOGD between 1994 and 2007 were included in the study. Postoperative complications were recorded. In addition, the number of episodes of aspiration, chest infection and hospitalisation was recorded. The incidence of recurrence of GORD and retching were also recorded.

Results Forty-five children with neurological impairment (26 males, 19 females) underwent TOGD. 31 had a primary TOGD and 14 had TOGD as a rescue procedure after failed fundoplication. The follow-up ranged from 2 to 144 months. There were no recurrences of GORD. Some patients for whom retching was a problem preoperatively continued to retch after surgery. The number of episodes of aspiration, chest infection and hospitalisation reduced after TOGD, with improvements in quality of life of the patients and their parents/carers.

Conclusion TOGD is safe and may be a definitive solution for GORD in children with neurological impairment.

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