Total Esophagogastric Separation in Neurologically Impaired Children: Outcome and Efficacy

Abstract

Background: Gastroesophageal reflux disease (GERD) is one of the most clinical disorders affecting the gastrointestinal tract of neurologically impaired children (NIC). The reported incidence of GERD in NIC ranges from 15% to 75%. For a long time Nissen fundoplication became the first choice for management with some complications. For this reason, and as an alternative to repeated fundoplications, total esophagogastric separation (TEGS) became popular in treating these cases. Even some studies consider TEGS as a primary approach for GERD in NIC. Purpose: The aim of the study was to assess the efficacy and outcome of total esophagogastric separation in cases of severe gastroesophageal reflux in neurologically impaired children. Materials and Methods: Medical records of 11 patients who underwent total esophagogastric separation (TEGS) with Roux en Y anastomosis for recurrent GERD in our institute in pediatric surgery unit, Medina children hospital, KSA, were reviewed retrospectively. Selective criteria included all cases of recurrent GERD in NIC after fundoplications. TEGS was not performed in any case as a primary procedure. Results: Our study included eleven cases, seven males and four females. Their ages ranged from 6 to 14 years. All of them were neurologically impaired, with difficulty to take oral feeds and all cases had GERD or its related complications preoperatively. Median operating time was 5 hours ranging from 3.5 to 7 hours with a median blood loss of 200 ml. Hospital stay ranged from 5 to 17 days with a median of 9 days and median ICU stay was 3.5 days. Complications occurred in four cases (36.3%) with no mortality. Three cases needed reoperations (27.2%). Two cases (18.2%) developed hiatus hernia and were operated between 8 and 10 months postoperatively. Two cases (18.2%) develop adhesive intestinal obstruction who underwent conservative management and passed smoothly. Conclusion: TEGS, is considered as a safe, effective and reliable operation for treating cases of recurrent GERD after fundoplications in neurologically impaired children especially those who are dependent on enteral tube feeding.