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Total esophagogastric dissociation (TEGD) in neurologically impaired children: the floor to parents. Updates Surg 2022; 74:1881-1887. [PMID: 36129620 DOI: 10.1007/s13304-022-01384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
Total esophagogastric dissociation (TEGD) was proposed to treat gastroesophageal reflux disease (GERD) both as a rescue in case of fundoplication failure and as first-line surgery in neurologically impaired children (NIC). Aim of the study is to evaluate the impact of TEGD on the quality of life (QoL) of both NIC and their caregivers focusing on the parents' point of view. A retrospective observational study was conducted on all NIC who underwent TEGD in our center between 2012 and 2022. A questionnaire centered on the parents' point of view and investigating QoL of NIC and their caregivers was administered to all patients' parents. Data were compared using Fisher exact test and Mann-Whitney test; a p-value < 0.05 was considered statistically significant. 12 patients were enrolled in the study. Parents reported improvements in weight gain (p = 0.03), sleep disorders, apnea, regurgitation and vomiting (p < 0.01). Caregivers also declared a decrease in number of hospitalizations, particularly related to severe respiratory infections and ab ingestis pneumonia (p = 0.01). We also documented a reduction of caregivers' worries during food administration (p < 0.01). 50% of parents whose children were subjected to both fundoplication and TEGD would suggest TEGD as first line surgical treatment instead of fundoplication. According to parents' point of view, TEGD improves significantly NIC QoL and 50% of them would enthusiastically suggest TEGD as first-line surgical approach to GERD in NIC.
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2
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Coletta R, Mussi E, Bianchi A, Morabito A. Modified Oesophago-Gastric Dissociation (M-OGD) - a technical modification. Updates Surg 2020; 73:775-778. [PMID: 33270180 PMCID: PMC8005385 DOI: 10.1007/s13304-020-00934-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/15/2020] [Indexed: 11/26/2022]
Abstract
Adhesions and fibrosis following failed primary surgery for severe gastro-oesophageal reflux (GOR) in neurologically impaired children (NI) can render mobilization of the lower oesophagus and oesophago-jejunal anastomosis a technically demanding exercise both at open surgery and laparoscopy. This paper presents the Modified Oesophago-Gastric Dissociation (M-OGD) as a less complex technical modification of the original Total Oesophago-Gastric Dissociation (TOGD). The stomach is detached from the oesophago-gastric junction with an articulated 5-mm stapler, leaving a 5-mm strip of stomach attached to the oesophagus. An end-to-side isoperistaltic oesophago-jejunostomy is created between the gastric stump and the isoperistaltic jejunal Roux loop. A jejuno-jejunal anastomosis restores bowel continuity. Between May 2018 and February 2020, M-OGD was performed on 3 NI patients with a weight of 9-27.3 kg (median = 14 kg). Median age at surgery was 60 months (18-180), median surgical time 170 min (146-280), median re-feeding time was 3 days (2-5), and median length of stay was 20 days (11-25). All patients healed primarily and after a median follow-up of 3 months, there were no problems related to the oesophago-jejunal anastomosis. M-OGD reduces the difficulties of redo oesophageal surgery following failed anti-reflux procedures, with a safer oesophago-jejunal anastomosis and a good long-term outcome.
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Affiliation(s)
- Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, FI, Italy.
- School of Environment and Life Science, University of Salford, Salford, UK.
| | - Elisa Mussi
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139, Florence, Italy
| | - Adrian Bianchi
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, FI, Italy
- School of Environment and Life Science, University of Salford, Salford, UK
- Department of Neurofarba, University of Florence, Viale Pieraccini 6, 50121, Florence, Italy
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3
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Total Oesophagogastric Dissociation in Neurologically Impaired Children: 18 Years' Experience and Long-term Follow-up. J Pediatr Gastroenterol Nutr 2020; 70:457-461. [PMID: 31913925 DOI: 10.1097/mpg.0000000000002626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
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Mattioli G, Wong MCY, Angotti R, Mazzola C, Arrigo S, Gandullia P, Mancardi M, Fusi G, Messina M, Zanaboni C, Razore B, Barabino A, Molinaro F. Total oesophago-gastric dissociation in neurologically impaired children: Laparoscopic vs robotic approach. Int J Med Robot 2019; 16:e2048. [PMID: 31797517 DOI: 10.1002/rcs.2048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 09/24/2019] [Accepted: 10/07/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate and compare the feasibility and short-term results of laparoscopic and robotic total oesophago-gastric dissociation (TOGD) with a Roux-en-Y oesophago-jejunostomy. Minimal invasive surgery has multiple advantages in neurologically impaired patients. Robotic approach has overcome disadvantages linked to laparoscopy, in particular, referring to the surgeon fatigue. METHODS A retrospective study comparing five laparoscopic and five robotic TOGD was conducted between February and October 2016 in Giannina Gaslini Children's Hospital and Section of Pediatric Surgery of Siena. Neurologically impaired children scheduled for TOGD were included. Age, sex, weight, symptomatology, presence of epilepsy, and preoperative X-ray contrast were considered. Operative time, hospital stay, postoperative complications, redo surgery, nutrition rehabilitation, and X-ray contrast study after 5 days and after 1 month from the intervention were recorded. RESULTS In our series, there were no intraoperative complications, no conversions to open surgery, and no vagal lesions. In two of five robotic cases, a pyloroplasty was necessary. The median operative time was statistically longer in the robotic group. One dehiscence in the robotic group was recorded, and no dumping episodes occurred. No statistical differences in terms of complications were detected. CONCLUSION TOGD is feasible both with laparoscopic and robotic-assisted surgery with similar results. Robotic approach is considered feasible. At the same time, high laparoscopic skills allow to reach the same results as robotic approach with shorter operative time.
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Affiliation(s)
- Girolamo Mattioli
- DINOGMI, University of Genoa, Genoa, Italy.,Paediatric Surgery Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy
| | - Michela C Y Wong
- DINOGMI, University of Genoa, Genoa, Italy.,Paediatric Surgery Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy
| | - Rossella Angotti
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | - Cinzia Mazzola
- Paediatric Surgery Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy
| | - Paolo Gandullia
- Pediatric Gastroenterology Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy
| | - Margherita Mancardi
- Pediatric Neuromuscular Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy
| | - Giulia Fusi
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | - Mario Messina
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | - Clelia Zanaboni
- Department of Pediatric Anesthesia, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy
| | - Barbara Razore
- Paediatric Surgery Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy
| | - Arrigo Barabino
- Pediatric Gastroenterology Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy
| | - Francesco Molinaro
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
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Taylor J, O'Neill M, Maddison J, Richardson G, Hewitt C, Horridge K, Cade J, McCarter A, Beresford B, Fraser LK. 'Your Tube': the role of different diets in children who are gastrostomy fed: protocol for a mixed methods exploratory sequential study. BMJ Open 2019; 9:e033831. [PMID: 31601609 PMCID: PMC6797291 DOI: 10.1136/bmjopen-2019-033831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/05/2019] [Accepted: 09/17/2019] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Increasing numbers of children require having all, or part, of their nutritional intake via gastrostomy. More parents are using home-blended meals to feed their children, with many reporting beneficial effects such as improved gastro-oesophageal reflux, less constipation and less distress in their child.This study aims to identify the important outcomes of tube feeding in this population, compare the safety, outcomes and resource use of those on a home-blended diet compared with a formula diet and assess feasibility of long-term follow-up of children recruited to this study. METHODS AND ANALYSES This is a mixed methods study of children (aged 6 months to 18 years) who are gastrostomy feed dependent recruited via general, community and specialist paediatric and dietetic services. Workstream1 (WS1): a qualitative study involving semistructured interviews with parents (n~20) and young people (n~5-10), and focus groups with health professionals (n~25), will provide evidence of appropriate outcome measures and the feasibility/acceptability of proposed data collection methods for WS2. It will gather data on: desired outcomes of gastrostomy feeding, variability in diets and reasons; use of oral feeding; perceived benefits of the alternative diets, resources associated with gastrostomy feeding and safety issues. Data will be analysed using thematic analysis. WS2: a cohort study of 300 children who are gastrostomy fed. Data will be collected at months 0, 9 and 18 from parents, children (if appropriate) and clinicians using standardised measures and questionnaires developed specifically for the study. Data collected will include gastrointestinal symptoms, health and other outcomes (child, parent), dietary intake, anthropometry, healthcare usage, safety outcomes and resource use. Outcomes in the home-blended and formula groups will be compared using appropriate multiple regression analyses. ETHICS AND DISSEMINATION The study has been approved by a research ethics committee (REC reference: 19/YH/0028). Results will be disseminated through publications and presentations for professionals and families. STUDY REGISTRATION NUMBER ISRCTN13977361.
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Affiliation(s)
- Johanna Taylor
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Mark O'Neill
- Martin House Research Centre, Department of Health Sciences,University of York, York, UK
| | - Jane Maddison
- Social Policy Research Unit, University of York, York, UK
| | | | | | - Karen Horridge
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Janet Cade
- Nutritional Epidemiology Group,University of Leeds, Leeds, UK
| | - Alison McCarter
- Somerset Partnership NHS and Social Care Trust, Bridgwater, UK
| | | | - Lorna Katharine Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
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Jamshidi R, Densmore JC, Gourlay DM, Lal DR, Calkins CM. Esophagojejunal Anastomosis by Circular Stapler in Pediatric Patients: Size Minima Defined by Experience and Geometry. J Laparoendosc Adv Surg Tech A 2019; 29:1311-1314. [PMID: 31549898 DOI: 10.1089/lap.2019.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Esophagojejunostomy is facilitated by use of a circular stapler, particularly when performed laparoscopically. The minimum patient size that will allow use of circular staplers in the small intestine is unknown. Materials and Methods: Retrospective review of esophagogastric dissociations performed at a single tertiary care institution for 48 months. This was combined with a geometric derivation of a size-estimation formula. Results: From the 7 cases identified, patients weighing >16 kg easily accommodated the 21 mm stapler. There was a narrow fit in the patient weighing 13.6 kg, and the 6 kg patient was too small for the stapler. Conclusions: Through a combination of clinical observation and physical reasoning, circular stapler applicability in small intestine is predicted by patient weight or intestinal measurement. Patients weighing >16 kg will accept the stapler, whereas patients <13 kg are likely too small. Alternately, on the basis of a geometric derivation, if the width of the flat intestine is >1.6 × the device diameter, the device will fit. This calculation can be applied broadly (e.g., incision length for laparoscopic ports or single-port access devices).
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Affiliation(s)
- Ramin Jamshidi
- Pediatric General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - John C Densmore
- Pediatric General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - David M Gourlay
- Pediatric General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Dave R Lal
- Pediatric General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Casey M Calkins
- Pediatric General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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7
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Tanaka Y, Tainaka T, Uchida H. Indications for total esophagogastric dissociation in children with gastroesophageal reflux disease. Surg Today 2018; 48:971-977. [PMID: 29435660 DOI: 10.1007/s00595-018-1636-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
Abstract
Total esophagogastric dissociation (TED) is used to treat gastroesophageal reflux (GER) after failed fundoplication in neurologically impaired patients. It is now performed for some otherwise healthy patients with severe GER. In this procedure, the gastrointestinal tract is reconstructed in a non-physiological way with a Roux-en-Y esophagojejunal anastomosis and jejuno-jejunostomy. Although TED eliminates almost all GER, some patients experience late complications. In this review, we investigated the long-term outcomes after TED to determine the best indications. In total, 147 neurologically impaired patients and 28 neurologically normal patients were identified. The total rate of complications requiring re-operation was 17.2% in neurologically impaired patients and 32.1% in normal patients, both higher than the rates associated with fundoplication. Although most authors added pyloroplasty when there was a concern of gastric emptying, this sometimes caused bile reflux. Nutritional and metabolic complications, including dumping syndrome and chronic digestive malabsorption, were also reported to occur after TED. TED is an option for the treatment of neurologically impaired patients with recurrent GER after fundoplication or who are at a high risk of recurrence of GER with fundoplication. However, neurologically normal patients who have the ability to obtain nutrition orally should consider options other than TED, as postoperative complications are frequent.
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Affiliation(s)
- Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, 339-8551, Japan.
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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8
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DeAntonio JH, Parrish DW, Rosati SF, Oiticica C, Lanning DA. Laparoscopic gastroesophageal dissociation in neurologically impaired children with gastroesophageal reflux disease. J Pediatr Surg 2017; 53:S0022-3468(17)30632-2. [PMID: 29103790 DOI: 10.1016/j.jpedsurg.2017.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/05/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE Neurologically impaired children with severe gastroesophageal reflux disease (GERD) are a challenging group of patients. We theorized that a laparoscopic gastroesophageal dissociation (LGED) may decrease reflux-related readmissions and healthcare visits, and improve quality of life (QOL) for them and their caregivers. METHODS A retrospective review was performed on our pediatric patients that underwent an LGED along with a caregiver survey from 2013 to 2017. RESULTS Twenty-two neurologically impaired patients (14months-17years) with severe GERD underwent an LGED. Patients weighed 7.9-57kg (avg=23.8kg), length of stay ranged from 5 to 20days (avg=12days), estimated blood loss ranged from <5cm3 to 450cm3 (avg=66cm3, median=25cm3), and duration of operation ranged from 299 to 641min (avg=462min). One death occurred on postoperative day 19 from gram negative sepsis (30-day perioperative mortality of 4.5%). There were a modest number of minor and major complications (follow-up avg.=13.7months, range=2-40months). There was a decrease in healthcare visits for respiratory illnesses (rated 5/5 from all 13/19 survey respondents) as well as improvements in perceived QOL of the patient (avg=4.3/5) and caregiver (avg=4.6/5). CONCLUSIONS Our cohort of patients had a reduction in readmissions and healthcare visits, and improved QOL after undergoing an LGED based on the perceptions of their caregivers. In neurologically impaired patients with severe GERD, an LGED may be a viable alternative to traditional treatments. TYPE OF STUDY Retrospective case series review. LEVEL OF EVIDENCE Level IV evidence: case series without comparison.
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Affiliation(s)
- Jonathan H DeAntonio
- Children's Hospital of Richmond at Virginia Commonwealth University (CHOR at VCU)
| | - Dan W Parrish
- Children's Hospital of Richmond at Virginia Commonwealth University (CHOR at VCU)
| | - Shannon F Rosati
- Children's Hospital of Richmond at Virginia Commonwealth University (CHOR at VCU)
| | - Claudio Oiticica
- Children's Hospital of Richmond at Virginia Commonwealth University (CHOR at VCU)
| | - David A Lanning
- Children's Hospital of Richmond at Virginia Commonwealth University (CHOR at VCU).
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Robotic-Assisted Minimally Invasive Total Esophagogastric Dissociation for Children with Severe Neurodisability. J Laparoendosc Adv Surg Tech A 2017; 27:550-555. [DOI: 10.1089/lap.2016.0399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chhabra S, Nedea AM, Kauffman L, Morabito A. Total esophagogastric dissociation: single center experience. J Pediatr Surg 2017; 52:260-263. [PMID: 27894768 DOI: 10.1016/j.jpedsurg.2016.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 01/12/2023]
Abstract
AIM Fundoplication fails in approximately 20% of children with severe neurodisability. We aimed to evaluate total esophagogastric dissociation (TOGD) as a primary procedure and as a ‘rescue’ procedure for severely neurologically impaired children with significant swallowing discoordination and gastroesophageal reflux disease. METHODS Casenotes of 40 children with severe neurodisability who underwent TOGD between 2005 and 2015 were retrospectively reviewed. Of these, 33 were primary procedures and 7 were ‘rescue’ procedures following failed fundoplication. RESULTS Median age at surgery was 3 years 7 months (range 1 month to 13 years 11 months). Preoperatively, all children had symptoms of regurgitation, retching or vomiting and 70% of children had an unsafe swallow. There were 5 early complications related to surgery in 4 children requiring surgical intervention. One child died following relaparotomy for esophagojejunal anastomotic breakdown because of multiorgan failure. Gastrostomy feeding was established by a median of 6 days (range 2 to 25 days) and median hospital stay was 10 days (range 4 to 280 days). There were 5 late complications. Median follow-up was 13 months (range 1 month to 8 years 4 months). All children have had resolution of gastroesophageal reflux. Thirteen percent of children experience bloating or pain on feeding and 26% of children experience retching unrelated to gastroesophageal reflux. There were 8 late deaths unrelated to surgery. CONCLUSION TOGD should be considered as a primary and definitive procedure in selected severely neurodisabled children who are at higher risk of failure of fundoplication, recurrent aspiration and a reduced quality of life.
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Affiliation(s)
- Sumita Chhabra
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Anca-Mihaela Nedea
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Lisa Kauffman
- Department of Paediatrics, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Antonino Morabito
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, United Kingdom.
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11
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Lansdale N, McNiff M, Morecroft J, Kauffmann L, Morabito A. 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. [PMID: 26210817 DOI: 10.1016/j.jpedsurg.2015.06.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Fundoplication has high failure rates in neurodisability: esophagogastric dissociation (TOGD) has been proposed as an alternative. This study aimed to compare the long-term and 'patient-reported' outcomes of TOGD and laparoscopic fundoplication (LapFundo). METHODS Matched cohort comparison comprises (i) retrospective analysis from a prospective database and (ii) carer questionnaire survey of symptoms and quality of life (CP-QoL-Child). Children were included if they had severe neurodisability (Gross Motor Function Classification System five) and spasticity. RESULTS Groups were similar in terms of previous surgery and comorbidities. The TOGD group was younger (22 vs. 31.5months, p=0.038) with more females (18/23 vs. 11/24, p=0.036). TOGD was more likely to require intensive care: operative time, length of stay and time to full feeds were all longer (p<0.0001). Median follow-up was 6.3 and 5.8years. Rates of complications were comparable. Symptom recurrence (5/24 vs. 1/23, p=0.34) and use of acid-reducing medication (13/24 vs. 4/23, p=0.035) were higher for LapFundo. Carer-reported symptoms and QoL were similar. CONCLUSIONS TOGD had similar efficacy to LapFundo (with suggestion of lower failure), with comparable morbidity and carer-reported outcomes. However, TOGD was more 'invasive,' requiring longer periods of rehabilitation. Families should be offered both procedures as part of comprehensive preoperative counseling.
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Affiliation(s)
- Nick Lansdale
- Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
| | - Melanie McNiff
- School of Medicine, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - James Morecroft
- Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Lisa Kauffmann
- Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Antonino Morabito
- Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
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12
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Barrett esophagus and esophagojejunal anastomotic stenosis as complications of esophagogastric disconnection in children with esophageal atresia. J Pediatr Gastroenterol Nutr 2013; 57:93-5. [PMID: 23535759 DOI: 10.1097/mpg.0b013e3182929ec2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Total esophagogastric disconnection (TED) is an alternative surgical procedure in resistant gastroesophageal reflux disease. We report 2 severe, not yet described long-term complications of TED occurring in 4 children with a history of esophageal atresia. Three children presented with stenosis of the esophagojejunal anastomosis 5 months to 9 years after TED, requiring repeated dilations associated with mitomycin C application in one of them. Barrett esophagus was observed in 3 children 8 to 9 years after TED. Careful long-term clinical and endoscopic follow-up of children who underwent TED is required.
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13
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Peters RT, Goh YL, Veitch JM, Khalil BA, Morabito A. Morbidity and mortality in total esophagogastric dissociation: a systematic review. J Pediatr Surg 2013; 48:707-12. [PMID: 23583122 DOI: 10.1016/j.jpedsurg.2012.11.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 10/14/2012] [Accepted: 11/13/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Total esophagogastric dissociation has been described as both a primary and a rescue procedure for patients with severe gastroesophageal reflux. Although most commonly used in the neurologically impaired, it has also been used in those with no neurological impairment. The main objective of this study was to determine morbidity and mortality for this procedure. METHODS All published cases of esophagogastric dissociation in children were identified. Series were updated where possible by personal communication with the author. Patient characteristics, indications, morbidity, and mortality were analyzed. RESULTS One hundred eighty-one cases were identified. One hundred seventeen were primary operations and 64 were rescue procedures. There were 29 (16.0%) early complications and 28 (15.5%) late complications with 6 (3.3%) deaths related to the procedure of a total of 35 deaths. Twenty-one patients (11.6%) required re-operation in the study periods. CONCLUSIONS Esophagogastric dissociation has an acceptable morbidity and mortality. It is useful as both a primary and a rescue procedure.
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Affiliation(s)
- Robert T Peters
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, M13 9WL, United Kingdom
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14
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Trigueiro LCDL, Lucena NMGD, Aragão PORD, Lemos MTM. Perfil sociodemográfico e índice de qualidade de vida de cuidadores de pessoas com deficiência física. FISIOTERAPIA E PESQUISA 2011. [DOI: 10.1590/s1809-29502011000300004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi identificar o perfil sociodemográfico e o nível de qualidade de vida de cuidadores de pessoas com deficiência física atendidas na Fundação Centro Integrado de Apoio ao Portador de Deficiência Física (FUNAD) no município de João Pessoa (PB). Participaram do estudo 51 cuidadores de pessoas com deficiência física, na faixa etária de 19 a 63 anos (36,29±11,10). Para a avaliação foram utilizados dois instrumentos: um formulário estruturado, com questões sobre o perfil pessoal e social dos cuidadores e o World Health Organization Quality of Life (WHOQOL-bref), para a análise do nível de qualidade de vida. Os resultados apontaram que a maioria dos cuidadores eram mulheres (92,2%), mães (68,6%), solteiras (43,1%) e haviam frequentado a escola até o Ensino Fundamental incompleto (47%). Houve significância estatística (p<0,05), com correlação positiva entre idade e tempo de atuação como cuidador atual (p=0,000); e correlação negativa entre escolaridade e tempo de cuidado diário (p=0,009). Constatou-se que o estresse físico e o emocional levam os cuidadores a ficarem sobrecarregados, afetando diretamente sua qualidade de vida. Ressalta-se a importância da investigação do estilo de vida desses cuidadores no intuito de que ações sociais e de saúde sejam desenvolvidas pelas instituições que assistem pessoas com deficiência física.
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