Indications for total esophagogastric dissociation in children with gastroesophageal reflux disease
- 11 Downloads
Total esophagogastric dissociation (TED) is used to treat gastroesophageal reflux (GER) after failed fundoplication in neurologically impaired patients. It is now performed for some otherwise healthy patients with severe GER. In this procedure, the gastrointestinal tract is reconstructed in a non-physiological way with a Roux-en-Y esophagojejunal anastomosis and jejuno-jejunostomy. Although TED eliminates almost all GER, some patients experience late complications. In this review, we investigated the long-term outcomes after TED to determine the best indications. In total, 147 neurologically impaired patients and 28 neurologically normal patients were identified. The total rate of complications requiring re-operation was 17.2% in neurologically impaired patients and 32.1% in normal patients, both higher than the rates associated with fundoplication. Although most authors added pyloroplasty when there was a concern of gastric emptying, this sometimes caused bile reflux. Nutritional and metabolic complications, including dumping syndrome and chronic digestive malabsorption, were also reported to occur after TED. TED is an option for the treatment of neurologically impaired patients with recurrent GER after fundoplication or who are at a high risk of recurrence of GER with fundoplication. However, neurologically normal patients who have the ability to obtain nutrition orally should consider options other than TED, as postoperative complications are frequent.
KeywordsTotal esophagogastric dissociation Gastroesophageal reflux Neurologically impaired Fundoplication
We thank Shohei Takami for collecting data and Hiroshi Kawashima for helpful discussion.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Conflict of interest
Yujiro Tanaka and the other co-authors have no conflicts of interest.
- 18.Lansdale N, McNiff M, Morecroft J, Kauffmann L, Morabito A. Long-term and ‘patient-reported’ outcomes of total esophagogastric dissociation versus laparoscopic fundoplication for gastroesophageal reflux disease in the severely neurodisabled child. J Pediatr Surg. 2015;50:1828–32.CrossRefPubMedGoogle Scholar
- 27.Zaidi T, Sudall C, Kauffmann L, Folaranmi S, Khalil B, Morabito A. Physical outcome and quality of life after total esophagogastric dissociation in children with severe neurodisability and gastroesophageal reflux, from the caregiver’s perspective. J Pediatr Surg. 2010;45:1772–6.CrossRefPubMedGoogle Scholar
- 29.Mathei J, Coosemans W, Nafteux P, Decker G, De Leyn P, Van Raemdonck D, et al. Laparoscopic Nissen fundoplication in infants and children: analysis of 106 consecutive patients with special emphasis in neurologically impaired vs. neurologically normal patients. Surg Endosc. 2008;22:1054–9.CrossRefPubMedGoogle Scholar
- 40.Virji A, Murr MM. Caring for patients after bariatric surgery. Am Fam Phys. 2006;73:1403–8.Google Scholar
- 48.Bellevue OC, Louie BE, Jutric Z, Farivar AS, Aye RW. A hill gastropexy combined with Nissen Fundoplication appears equivalent to a Collis-Nissen in the management of short esophagus. J Gastrointest Surg. In press.Google Scholar