Total esophagogastric dissociation: an alternative approach

Abstract

Background/methods: The authors report experience with five children, four of whom underwent esophagogastric dissociation with a Roux-en-Y esophagojejunal anastomosis and jejuno-jejunostomy after recurrent failure of fundoplication to control gastroesophageal reflux. A fifth child had a similar temporary gastric dissociation because of life-threatening aspiration caused by reflux into a colonic neoesophagus. Reversal is planned when the child has achieved sufficient physical growth and accepts a substantial oral intake. Feeding into the dissociated stomach was by intermittent catheterization of a nonrefluxing gastrostomy in four children and a Stamm tube gastrostomy in one child. The postoperative course and follow-up were notable for the rapid improvement in the children's general condition and nutritional status and the reduction in the frequency of pneumonitis. Reflux did not recur.

Results: Review of the postoperative course led to a restructuring of surgical management with the development of tailored 'patient-specific' plans based on short-term and long-term prognosis. Failure to thrive, difficulty in child handling, gastroesophageal reflux, and neurological and physical impairment are particular considerations.

Conclusions: The author's limited experience leads us to suggest that esophagogastric dissociation with Roux-en-Y esophagojejunostomy and a nonrefluxing feeding gastrostomy is a useful temporary or permanent 'rescue' procedure. Furthermore, it is the author's view that the procedure may have a useful role as the primary form of management when normal oral feeding is unlikely to become established.