Esophagogastric separation for failed fundoplication in neurologically impaired children

Purpose: Recurrent gastroesophageal reflux (GER) after a fundoplication in severely neurologically impaired children is a frustrating problem without an effective solution: redo fundoplications carry a significant recurrence rate and gastrojejunostomy (GJ) tube feedings are associated with frequent tube dislodgment. The authors report a series of esophagogastric separation (EGS) procedures aimed at the management of failed fundoplication in neurologically impaired children. Methods: Medical records of 10 patients who underwent EGS for recurrent GER were reviewed retrospectively. Variables examined included diagnosis, preoperative problems, operative and perioperative data, and outcomes. Results: None of the patients were feeding orally and all were dependent on tube feedings. A median of 1.5 (range, 1 to 3) fundoplications had been performed previously and failed. All had preoperative emesis and feeding intolerance. Eight had failure to thrive and 5 recurrent pneumonias. Median age at the time of the procedure was 7.5 years (range, 2 to 22). Median postoperative length of stay was 9 days (range, 5 to 17), and there were no leaks from the anastomosis. Salivary secretion intolerance was the most common postoperative problem (5 of 10 patients). Repeat exploration was required for perforation of the colon in one and paraesophageal hernia in another. Recurrent GER was not noted. All 9 currently surviving children are tolerating bolus gastrostomy feedings, which was an advantage to the parents. Conclusions: EGS is an attractive alternative for failed fundoplication in severely neurologically impaired children.