Esophagogastric disconnection following failed fundoplication for the treatment of gastroesophageal reflux disease (GERD) in children with severe neurological impairment

Silvia Buratti, Rose Kamenwa, Ranjan Dohil, David Collins, Joel E. Lavine

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Abstract

This report describes our experience with esophagogastric disconnection and Roux-en-Y esophagojejunostomy for the treatment of gastroesophageal reflux disease (GERD) in seven neurologically impaired children as a second antireflux operation following failed Nissen fundoplication. After a mean follow-up of 3 years, three children (43%) were completely or almost completely symptom-free and had improved nutritional status. Early complications occurred in three patients (43%): small bowel obstruction, wound infection, and necrosis of the Roux-en-Y loop. Three patients (43%) presented long-term complications: jejunoesophageal bile reflux and bile reflux with gastric irritation. Two patients required reoperation (28%), and two deaths occurred in the postoperative period (28%). In three previous reports in the surgical literature, severe postoperative complications occurred in 0-44%, requiring reoperation in 0-22% of the patients, and the mortality rate was 0-11%. Esophagogastric disconnection for the treatment of GERD in neurologically impaired children is associated with major complications and should be considered after more conservative procedures fail.

Original languageEnglish
Pages (from-to)786-790
Number of pages5
JournalPediatric Surgery International
Volume20
Issue number10
DOIs
Publication statusPublished - Oct 2004

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Keywords

  • Antireflux surgery
  • Esophagogastric disconnection
  • Neurologically impaired children

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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