Due to the failure rate of fundoplications ranging from 16% to 38%, total oesophagogastric dissociation (TOGD) is an alternative antireflux operation for neurologically challenged children. The feasibility and long-term effectiveness of TOGD as a primary and “rescue” surgery after failed fundoplication are assessed in this study. Thirty patients who underwent TOGD in two Italian centers between 2000 and 2018 were evaluated retrospectively. There were 23 primary operations and 7 “rescue” procedures. Severe neurodisability, persistent gastroesophageal reflux, and dysphagia were the inclusion criteria. All of the children experienced regurgitation, vomiting, or retching before surgery, and 93 percent had hazardous swallowing and aspiration, as well as recurring chest infections/aspiration pneumonia. The median relative weight was 77%. Prior to surgery, all patients were receiving antireflux medication. The average age at TOGD was 6.48 years. The average period of follow-up was 3.5 years. There was no return of gastroesophageal reflux (GER) or vomiting. The number of chest infections and length of hospital stay both decreased significantly, while the median relative weight increased by 101 percent. The perception of results by parents/caregivers improved significantly. Six individuals developed early problems, with three requiring surgical intervention. Three late problems necessitated surgery as well. There was no surgical-related death.
TOGD is a successful surgery with a low complication rate for children with severe neurological impairment, and it results in a significant improvement in general health and quality of life for children and families. There was no significant difference in results between the Primary and “Rescue” treatments.
Reference:https://journals.lww.com/jpgn/Fulltext/2020/04000/Total_Oesophagogastric_Dissociation_in.16.aspx
