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Total oesophago-gastric dissociation; is there a role for such a procedure?
Sello Machaea, Colin Lazarus
Walter Sisulu University
Introduction
Total oesophago-gastric dissociation is a rescue procedure used in severely neurologically impaired children where a previously performed antireflux procedure had failed. The procedure entails completed dissociation of the oesophagus to the stomach with a Roux-en-Y oesophago-jejunostomy and Stamm gastrostomy performed. This case report describes the outcome in such patients.
Method
Retrospective review of patients who underwent a total oesophago-gastric dissociation (TODG) procedure at Life Beacon Bay Hospital.
Case 1:
5year old girl with encephalopathy syndrome who presented at 2years of age with severe gasto-oesophageal reflux, confirmed on 24hr pH study. Underwent laparoscopic Nissen Funduplication with a feeding gastrostomy soon thereafter. Unremarkable recovery. Presented 2years later with vomiting and retching; on gastroscope, had no oesophagitis with snug ‘valve’ and gastritis. H Pylori was detected on biopsy specimen. Subsequently presented to the paediatricians with repeated episodes of hyperactive airway with wheezing and respiratory distress, attributed to reflux. A good weight was maintaining throughout this period. She underwent an open TOGD with no reported reflux episodes thereafter.
Case 2:
13year old boy with spastic cerebral palsy who presented with feeding difficulty, malnutrition and gastro-oesophageal reflux. Underwent laparoscopic Thal Funduplication with a feeding gastrostomy with an unremarkable recovery. Was managed by paediatricians over a 2year period with satisfactory weight gain but recurrent lower respiratory tract infections. Contrast swallow showed persistent reflux. He underwent an open TOGD with no further reported reflux.
Conclusion
Despite the limited number in this cohort, children who underwent TOGD were able to maintain weight and avoid recurrent reflux episodes and had decreased hospital visits. TOGD is a procedure worth considering in severely neurologically impaired children who remain symptomatic despite previous antireflux procedure.