TITLE:
Total Esophagogastric Separation in Neurologically Impaired Children: Outcome and Efficacy
AUTHORS:
Rady Awad Elsherbini
KEYWORDS:
Total Esophagogastric Separation, Gastro-Esophageal Reflux, Nissen Fundoplication
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.9 No.2,
May
13,
2019
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.