Esophagogastric dissociation reduces the re-operation rate for persistent gastroesophageal reflux in severely neurologically impaired children

Abstract

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.

Total Esophageal Gastric Dissociation for the Failed Antireflux Procedure in a Child with Microgastria

“…TEGD has been reported as achieving good outcomes not only as a salvage procedure for failed antireflux procedures in children with severe neurological impairment but as a primary antireflux procedure in those populations. 4,[12][13][14][15] Gatti et al showed a marked reduction in reflux symptoms and an improved quality of life with TEGD when compared with fundoplication in neurologically impaired patients. 16 Buratti et al suggested TEGD be reserved only for repeated failed antireflux procedures.…”

Total oesophago‐gastric dissociation in neurologically impaired children: Laparoscopic vs robotic approach

“…5 In neurologically impaired children, especially in ones affected by seizures, the risk of recurrence of GOR and mortality after a fundoplication is higher compared with patients with a normal neurological level. 1,2,[6][7][8][9][10][11] For this reason, in recent years, TOGD has obtained an higher consensus in the surgical treatment of GOR in this kind of patients. In fact, it is now considered as a valid option not only as a 'rescue' intervention in patients with recurrence of GOR after fundoplication, but also as primary procedure with good results.…”

“…In fact, it is now considered as a valid option not only as a 'rescue' intervention in patients with recurrence of GOR after fundoplication, but also as primary procedure with good results. 2,6,[12][13][14] Our recent analysis of outcome has shown that the presence of seizures is a significant risk factors for surgical success of Nissen fundoplication. 15 This study, comparing five laparoscopic TOGD and five robotic TOGD, was conducted after checking the feasibility of TOGD by robotics.…”

“…For 1 children with gastro-oesophageal reflux (GOR) and a neurological impairment, especially for ones affected by seizures, the TOGD can be considered a valid alternative method, not only as a "rescue" intervention after fundoplication but also as first intervention choice. [2][3][4][5] There are recent studies that underline the advantages of TOGD compared with the minimally invasive fundoplication techniques for the treatment of gastro-oesophageal reflux disease (GORD) in patients with severe neurological impairment. One of the disadvantages of this technique was the need, at the beginning, to be performed with an open approach, while the fundoplication has been developed, in the last two decades, as a laparoscopic procedure.…”

Total oesophagogastric dissociation for severe gastro‐oesophageal reflux in children with previous upper gastrointestinal surgery: A new route for an old tract

“…Since the first proposal of TOGD in 1997 by Bianchi, TOGD has emerged as a promising alternative surgical option in the treatment of failed fundoplication. Despite the absence of data from randomized, controlled trials to suggest the superiority of TOGD over other approaches, comparative studies have shown a higher success rate with TOGD in treating GOR (approaching 100 per cent) in comparison to fundoplication or gastrojejunostomy . Both patients presented here had a common problem of severe intraabdominal adhesion due to previous gastric/duodenal surgery, thereby rendering fundoplication difficult, if not impossible.…”