Total Oesophagogastric Dissociation in Neurologically Impaired Children

Objectives: Total oesophagogastric dissociation (TOGD) is an alternative antireflux surgery for neurologically impaired children because of a 16% to 38% fundoplication failure rate. This study evaluates TOGD's feasibility and its long‐term efficacy both as a Primary and as a “Rescue” procedure after failed fundoplication. Methods: Thirty patients (18 boys) who underwent TOGD between 2000 and 2018 in 2 Italian Centres were retrospectively reviewed. Twenty‐three were Primary procedures and 7 were “Rescue” ones. Inclusion criteria were severe neurodisability, intractable gastroesophageal reflux, and dysphagia. Results: Preoperatively, all children had regurgitation, vomiting or retching, and 93% had unsafe swallowing and aspiration, with recurrent chest infections/aspiration pneumonia. Median relative weight was 77% (48%‐‐118%). All patients were taking antireflux medication before surgery. Median age at TOGD was 6.48 years (0.69‐‐22.18). Median follow‐up was 3.5 years (0.6–17.7). No recurrence of gastroesophageal reflux (GER) and vomiting was recorded. The number of chest infections and length of hospital stay showed a significative decrease ( P value <0.0001 for both), whereas median relative weight reached 101% ( P value 0.002). Parents’/caregivers’ perception of outcome showed a significative improvement. Six patients (20%) experienced early complications and 3 required surgical intervention. Three late complications (10%) also required surgery. There was no surgery‐related mortality. Conclusion: TOGD is an effective procedure with an acceptably low complication rate for children with severe neurological impairment and is followed by a major improvement in general health and quality of life for children and families. There was no substantial difference in outcome between Primary and “Rescue” procedures.