Total esophagogastric dissociation (TEGD): Lessons from two decades of experience

      Abstract

      Background

      Total esophagogastric dissociation (TEGD) has been performed in our institution since 1994, predating its published description by Bianchi in 1997. Originally it was considered a rescue procedure when conventional antireflux surgery failed. Recently TEGD has been considered a viable primary option for the treatment of gastroesophageal reflux disease (GERD) in severely neurological impaired (NI) patients. We describe our institution’s experience of TEGD in this selected cohort of patients.

      Methods

      An institutional retrospective review was performed detailing our total experience of open TEGD between 1994 and 2015 in severely neurologically impaired (NI) patients. Demographic, complications, and outcome were analyzed.

      Results

      Sixty-six NI patients underwent TEGD between 1994 and 2015 (39 female). Primary TEGD was performed in forty-nine patients (74.2%), while the remainder were rescue procedures following the failure of previous antireflux surgery. In 98% of cases no recurrence of clinically significant reflux was reported. The mean hospital length of stay was 10.2 days. There were sixteen reported complications in twelve patients representing 18.2% of the cohort. One death was attributable to the procedure (1.5%). Median follow-up was 31.6 months (range, 1.3–137.9 months).

      Conclusion

      TEGD appears to be a valid surgical option to treat severe GERD in severely neurologically impaired children, both as a primary procedure and as a rescue procedure following failure of anti-reflux surgery. Further studies comparing TEGD versus laparoscopic fundoplication are desirable to understand which of these procedures can be the most effective in this compromised group of patients.
      Type of study: Retrospective study
      Level of evidence: IV

      Key words

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      References

        • Manikam R.
        • Perman J.A.
        Pediatric feeding disorders.
        J Clin Gastroenterol. 2000; 30: 34-46
        • Romano C.
        • van Wynckel M.
        • Hulst J.
        • et al.
        European Society for Paediatric Gastroenterology, hepatology and nutrition guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment.
        J Pediatr Gastroenterol Nutr. 2017; 65: 242-264
        • Hauer J.
        Feeding intolerance in children with severe impairment of the central nervous system: strategies for treatment and prevention.
        Children (Basel). 2017; 5
        • Wadie G.M.
        • Lobe T.E.
        Gastroesophageal reflux disease in neurologically impaired children: the role of the gastrostomy tube.
        Semin Laparosc Surg. 2002; 9: 180-189
        • Borie F.
        • Zarzavadjian le Bian A.
        • Millat B.
        Long-term quality of life in gastroesophageal reflux disease after NISSEN fundoplication: does it depend on preoperative responsiveness to proton pump inhibitors?.
        Surg Laparosc Endosc Percutan Tech. 2014; 24: 332-336
        • Wockenforth R.
        • Gillespie C.S.
        • Jaffray B.
        Survival of children following Nissen fundoplication.
        Br J Surg. 2011; 98: 680-685
        • Dedinsky G.K.
        • Vane D.W.
        • Black T.
        • et al.
        Complications and reoperation after Nissen fundoplication in childhood.
        Am J Surg. 1987; 153: 177-183
      1. Islam S, Teitelbaum DH, Buntain WL, Hirschl RB. Esophagogastric separation for failed fundoplication in neurologically impaired children. J Pediatr Surg 2004;39(3):287-91; discussion -91.

        • Cheung K.M.
        • Tse H.W.
        • Tse P.W.
        • et al.
        Nissen fundoplication and gastrostomy in severely neurologically impaired children with gastroesophageal reflux.
        Hong Kong Med J. 2006; 12: 282-288
        • Pacilli M.
        • Eaton S.
        • Maritsi D.
        • et al.
        Factors predicting failure of redo Nissen fundoplication in children.
        Pediatr Surg Int. 2007; 23: 499-503
        • Bianchi A.
        Total esophagogastric dissociation: an alternative approach.
        J Pediatr Surg. 1997; 32: 1291-1294
        • Morabito A.
        • Lall A.
        • Lo Piccolo R.
        • et al.
        Total esophagogastric dissociation: 10 years' review.
        J Pediatr Surg. 2006; 41: 919-922
        • Chhabra S.
        • Nedea A.M.
        • Kauffman L.
        • et al.
        Total esophagogastric dissociation: single center experience.
        J Pediatr Surg. 2017; 52: 260-263
        • Palisano R.J.
        • Rosenbaum P.
        • Bartlett D.
        • et al.
        Content validity of the expanded and revised Gross Motor Function Classification System.
        Dev Med Child Neurol. 2008; 50: 744-750
        • O'Neill J.K.
        • O'Neill P.J.
        • Goth-Owens T.
        • et al.
        Care-giver evaluation of anti-gastroesophageal reflux procedures in neurologically impaired children: what is the real-life outcome?.
        J Pediatr Surg. 1996; 31: 375-380
        • Waters E.
        • Davis E.
        • Mackinnon A.
        • et al.
        Psychometric properties of the quality of life questionnaire for children with CP.
        Dev Med Child Neurol. 2007; 49: 49-55
        • Lansdale N.
        • McNiff M.
        • Morecroft J.
        • et al.
        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: 1828-1832
        • Lall A.
        • Morabito A.
        • Bianchi A.
        "Total gastric dissociation (TGD)" in difficult clinical situations.
        Eur J Pediatr Surg. 2006; 16: 396-398
        • Ponsky T.
        • Wulkan M.
        • Holcomb G.
        • von Allmen D.
        • Harmon M.
        Stay current in pediatric surgery: annual update course.
        2017
        • Gatti C.
        • di Abriola G.F.
        • Villa M.
        • et al.
        Esophagogastric dissociation versus fundoplication: Which is best for severely neurologically impaired children?.
        J Pediatr Surg. 2001; 36: 677-680
        • Tabrizian F.
        • Raisolsadat S.M.
        • Houshmand B.
        • et al.
        Assessment of the necessity of sac high ligation in inguinal hernia open surgery among children.
        J Pediatr Surg. 2013; 48: 547-549
        • Buratti S.
        • Kamenwa R.
        • Dohil R.
        • et al.
        Esophagogastric disconnection following failed fundoplication for the treatment of gastroesophageal reflux disease (GERD) in children with severe neurological impairment.
        Pediatr Surg Int. 2004; 20: 786-790
        • Peters R.T.
        • Goh Y.L.
        • Veitch J.M.
        • et al.
        Morbidity and mortality in total esophagogastric dissociation: a systematic review.
        J Pediatr Surg. 2013; 48: 707-712
        • Diaz D.M.
        • Gibbons T.E.
        • Heiss K.
        • et al.
        Antireflux surgery outcomes in pediatric gastroesophageal reflux disease.
        Am J Gastroenterol. 2005; 100: 1844-1852
        • Mathei J.
        • Coosemans W.
        • Nafteux P.
        • 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: 1054-1059
        • Martinez D.A.
        • Ginn-Pease M.E.
        • Caniano D.A.
        Sequelae of antireflux surgery in profoundly disabled children.
        J Pediatr Surg. 1992; 27 (discussion 71-3): 267-271
        • Boubnova J.
        • Hery G.
        • Ughetto F.
        • et al.
        Laparoscopic total esophagogastric dissociation.
        J Pediatr Surg. 2009; 44: e1-e3
        • Mattioli G.
        • Buffa P.
        • Gandullia P.
        • et al.
        Laparoscopic proximal Roux-en-Y gastrojejunal diversion in children: preliminary experience from a single center.
        J Laparoendosc Adv Surg Tech A. 2009; 19: 807-813
        • DeAntonio J.H.
        • Parrish D.W.
        • Rosati S.F.
        • et al.
        Laparoscopic gastroesophageal dissociation in neurologically impaired children with gastroesophageal reflux disease.
        J Pediatr Surg. 2017; (pii:S0022-3468(17)30632-2)https://doi.org/10.1016/j.jpedsurg2017.10.010
        • Mattioli G.
        • Molinaro F.
        • Paraboschi I.
        • Leonelli L.
        • Mazzola C.
        • Arrigo S.
        • et al.
        Robotic-assisted minimally invasive total esophagogastric dissociation for children with severe neurodisability.
        J Laparoendosc Adv Surg Tech A. 2017; 27: 550-555
        • Lauriti G.
        • Lisi G.
        • Lelli Chiesa P.
        • et al.
        Gastroesophageal reflux in children with neurological impairment: a systematic review and meta-analysis.
        Pediatr Surg Int. 2018; 34: 1139-1149
        • Tanaka Y.
        • Tainaka T.
        • Uchida H.
        Indications for total esophagogastric dissociation in children with gastroesophageal reflux disease.
        Surg Today. 2018; 48: 971-977