Esophagogastric Dissociation for GERD in Severe Neurodisability

Esophagogastric dissociation was historically thought of as a last resort operation when Nissen fundoplication won't work.

Esophagogastric dissociation is now being suggested as an upfront primary operation for a small subset of patients with severe neurologic impairment.

The study compared patients with severe GERD and neurologic disability, half undergoing esophagogastric dissociation and half undergoing laparoscopic Nissen.

Primary outcome was operative failure, defined as either recurrence of preoperative reflux symptoms or requirement of additional anti-reflux surgery.

There was a 4% failure rate in the esophagogastric dissociation group and a 21% failure rate in the Nissen group.

The difference in failure rates between esophagogastric dissociation (4%) and Nissen (21%) was not statistically significant.

17% of patients in the esophagogastric dissociation group continued to require anti-reflux medications after surgery, compared to 54% in the Nissen group.

The difference in continued requirement for anti-reflux medications (17% vs 54%) was statistically significant.

Caregiver-evaluated quality of life and symptom scores were the same between the two groups with no statistically significant difference.

The lack of statistical significance in failure rates could potentially be a type 2 error where there was actually a difference but the sample size was too small to detect it.

The study examined perioperative factors including time in the OR, length of hospital stay, need for ICU stay, and time to full feeds, with statistically significant differences following expected trends.

The study did not report on leaks, strictures, or long-term requirement for additional surgeries other than anti-reflux operations.