Esophagogastric dissociation versus fundoplication: Which is best for severely neurologically impaired children?

Purpose: Neurologically impaired children (NIC) often have swallowing diffi culties, severe gastroesophageal reflux, recurrent respiratory infections, and malnutrition. Bianchi pro posed esophagogastric dissociation (EGD) as a n alternative to fundoplication and gastrostomy. The authors compared these 2 approaches. Methods: Twenty-nine consecutive symptomatic NIC refractory to medical ther apy were enrolled in a prospective study and divided into 2 groups: A (n = 12), NIC who underwent fundoplication and gastrostomy; B (n = 14), NIC who underwent EGD. Three were excluded because of previous fundoplication, Anth ropometric (percentage of the 50th percentile/ age of healthy children) and biochemical parameters, respiratory infections per year, hospitalization ( days per year), feeding time (minutes), and "quality of life" (parental psy chological questionnaire, range 0 to 60), were analyzed (t test and Mann-Wh itney test) preoperatively and 1 year postoperatively. Complications were r ecorded. Results: Compared with group A, group B presented a statistically significa nt increase of all anthropometric and nearly all biochemical parameters wit h a statistical difference in terms of respiratory infections, hospital sta y, feeding time, and psychological questionnaire. In group A, 2 bowel obstr uctions, 1 tight fundoplication, 1 dumping syndrome, and 3 failures of fund oplication occurred. Group B presented 1 anastomotic stricture, 1 paraesoph ageal hernia, and 1 bowel obstruction. Conclusions: Compared with fundoplication and gastrostomy, EGD offered bett er nutritional rehabilitation, reduction in respiratory infections, and imp roved quality of life. EGD can be rightfully chosen as a primary procedure. J Pediatr Surg 36:677-680. Copyright (C) 2001 by W.B. Saunders Company.