Esophagogastric dissociation versus fundoplication: Which is best for severely neurologically impaired children?

Long-term outcome of laparoscopic Nissen-Rossetti fundoplication for neurologically impaired and normal children

“…In the subgroup of children with long-term recurrence, often because of increased spasticity, esophagogastric dissociation, as reported by Bianchi [20] probably is the reoperation of choice. Some teams propose this Bianchi esophagogastric dissociation as a first procedure [21,22], but considering our results with 14 of 15 GERD cases among NI children controlled by a laparoscopic fundoplication, we concluded that the Bianchi procedure, performed through a laparotomy, must be reserved for the second procedure if needed.…”

Esophagogastric separation for failed fundoplication in neurologically impaired children

“…Esophagogastric separation (EGS) with a Roux-en-Y anastomosis has been used since the 1990s for this group of children with good results. [11][12][13] The majority of reports have been for a primary such procedure, without a previous fundoplication. 12, 13 We present our experience with EGS in neurologically impaired children with recurrent reflux after a fundoplication.…”

Risks and benefits of surgical management of gastroesophageal reflux in neurologically impaired children

“…This fascinating procedure is not substantiated by a relevant number of reports in the literature, and those that do appear describe a failure rate of about 40%, which is certainly higher than those of ARP and gastrostomy [4,6].…”

“…Several groups prefer to perform a feeding gastrostomy alone, and others a feeding gastrostomy associated with an antireflux procedure; recently an esophagogastric disconnection has also been described [3,6,10,19].…”