Total esophagogastric dissociation (TEGD): Lessons from two decades of experience
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In brief
In brief
Retrospective analysis of 66 neurologically impaired patients who underwent total esophagogastric dissociation (TEGD) over 21 years demonstrates 98% success rate in controlling severe GERD, with 18.2% complication rate and 1.5% mortality. TEGD proved effective both as primary intervention and rescue procedure after failed conventional antireflux surgery.
Written by the GCMD Library team from the article.
Background
Total esophagogastric dissociation (TEGD) has been performed in our institution since 1994, predating its published description by Bianchi in 1997. Originally it was considered a rescue procedure when conventional antireflux surgery failed. Recently TEGD has been considered a viable primary option for the treatment of gastroesophageal reflux disease (GERD) in severely neurological impaired (NI) patients. We describe our institution's experience of TEGD in this selected cohort of patients.
Methods
An institutional retrospective review was performed detailing our total experience of open TEGD between 1994 and 2015 in severely neurologically impaired (NI) patients. Demographic, complications, and outcome were analyzed.
Results
Sixty-six NI patients underwent TEGD between 1994 and 2015 (39 female). Primary TEGD was performed in forty-nine patients (74.2%), while the remainder were rescue procedures following the failure of previous antireflux surgery. In 98% of cases no recurrence of clinically significant reflux was reported. The mean hospital length of stay was 10.2 days. There were sixteen reported complications in twelve patients representing 18.2% of the cohort. One death was attributable to the procedure (1.5%). Median follow-up was 31.6 months (range, 1.3–137.9 months).
Conclusion
TEGD appears to be a valid surgical option to treat severe GERD in severely neurologically impaired children, both as a primary procedure and as a rescue procedure following failure of anti-reflux surgery. Further studies comparing TEGD versus laparoscopic fundoplication are desirable to understand which of these procedures can be the most effective in this compromised group of patients.
Type of study: Retrospective study
Level of evidence: IV