# Esophagogastric Dissociation for GERD in Severe Neurodisability — GCMD Library

Dr. Ian Glenn and Dr. Todd Ponsky discuss an article comparing esophagogatric dissociation and laparoscopic Nissen fundoplication in patients with severe gastroesophageal reflux disease (GERD) and severe neurodisability

Type: video · 2 min · posted 2019-01-11
Canonical: https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962

## Chapters
- [0:04](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=4) Introduction and Historical Context
- [0:48](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=48) Study Design and Primary Outcomes
- [1:49](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=109) Discussion of Limitations and Perioperative Factors

## Statements
- "Esophagogastric dissociation was historically thought of as a last resort operation when a Nissen won't work" — Todd Ponsky (clinical) [0:14](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=14)
- "Esophagogastric dissociation is being suggested as an upfront primary operation for a small subset of patients who have severe neurologic impairment" — Todd Ponsky (clinical) [0:24](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=24)
- "The study compared patients with severe GERD who were neurologically disabled, half undergoing esophagogastric dissociation and half undergoing laparoscopic Nissen" — Ian Glenn (clinical) [0:48](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=48)
- "Primary outcome was operative failure, defined as either recurrence of preoperative reflux symptoms or requirement of additional anti-reflux surgery" — Ian Glenn (clinical) [1:01](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=61)
- "There was a 4% failure rate in the esophagogastric dissociation group" — Ian Glenn (clinical) [1:13](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=73)
- "There was a 21% failure rate in the Nissen group" — Ian Glenn (clinical) [1:13](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=73)
- "The difference in failure rates between esophagogastric dissociation and Nissen was not statistically significant" — Ian Glenn (clinical) [1:21](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=81)
- "17% of patients in the esophagogastric dissociation group continued to require anti-reflux medications after surgery" — Ian Glenn (clinical) [1:29](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=89)
- "54% of patients in the Nissen group continued to require anti-reflux medications after surgery" — Ian Glenn (clinical) [1:29](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=89)
- "The difference in continued medication requirement between groups was statistically significant" — Ian Glenn (clinical) [1:29](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=89)
- "Caregiver-evaluated quality of life and symptom scores were the same between the two groups with no statistically significant difference" — Ian Glenn (clinical) [1:39](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=99)
- "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" — Ian Glenn (opinion) [2:03](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=123)
- "A multi-center study will probably be needed to really understand the difference between these procedures" — Todd Ponsky (opinion) [2:12](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=132)
- "The study did not adequately look at complication rates such as leaks and strictures" — Todd Ponsky (clinical) [2:16](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=136)
- "Leaks and strictures are the main concern of why most surgeons don't do esophagogastric dissociation" — Todd Ponsky (opinion) [2:18](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=138)
- "Esophagogastric dissociation is a much bigger surgery than Nissen fundoplication" — Ian Glenn (clinical) [2:24](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=144)
- "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" — Ian Glenn (clinical) [2:26](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=146)
- "The study did not report on leaks, strictures, or long-term requirement for additional surgeries other than anti-reflux operations" — Ian Glenn (clinical) [2:39](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=159)

## Transcript
This is Todd Ponsky from the Journal of Pediatric Surgery, and today we're going to discuss the topic about Nissen fundopliccation and esophagogastric dissociation. The dissociation was thought of historically as sort of the last resort operation, the big operation when a Nissan won't work, where we dissociate the esophagus from the stomach. But more recently, people are suggesting that the esophagogastric dissociation could be an upfront primary operation for a small subset of patients who have severe neurologic impairment. And so there was a study recently in the Journal of Pediatric Surgeon that looked at this. Discussing the article today is Ian Glenn, who is the pediatric surgery research fellow here at Akron Children's. He's a general surgery resident at the Cleveland Clinic. Ian, what did the article show? What this study did was they took patients who had severe GERD and were neurologically disabled, and half the patients underwent esophagogastric dissociation, and the other half of the patients underwent laparoscopic Nissan. Primary outcome was operative failure, which they defined as either recurrence of their preoperative reflux symptoms or a requirement of an additional uh anti-reflux surgery. So that was found to be, there was a 4% failure rate in the esophagogastric dissociation group, there was a 21% failure rate in the Nissen group. However, that wasn't statistically significant. Other things they looked at were a continued requirement for anti-reflux medications after surgery. Uh, 17% of the patients in the esophagogastric dissociation group continued to require them, whereas 54% required it in the Nissan group, um, and that was statistically significant. Also, they had the caregivers evaluate quality of life and symptom scores for the patients, and those were the same between the two groups. So there's no statistically significant difference there. All right, so in summary, it sounds like they looked at. Needing meds after surgery and failure of the operation, both were better in the esophageal dissociation group, but only the meds was statistically significant. Right? And the authors brought up that this could potentially be a type 2 error where there was actually a difference between the two groups and the sample size was just a little bit too small to detect that. Yeah, so we'll probably need to do a multi-center study to really understand this. Agreed. They also didn't really look at complication rate. About leaks and strictures, which are really the concern of why most of us don't do this big operation. Yeah, it's definitely a much bigger surgery. They looked at perioperative factors such as time in the OR, length of stay in the hospital, need for an ICU stay, time to full feeds, and there were statistically significant differences in those groups following the trends you'd expect. But no, they didn't talk about leaks or strictures or a long-term requirement for additional surgeries other than anti-reflux operations. Great, perfect. Ian Glenn, thank you very much. Thanks, do.

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Not medical advice · citation policy: https://library.globalcastmd.com/ai