Esophagogastric Dissociation for GERD in Severe Neurodisability

Esophagogastric dissociation was historically considered a last resort operation when Nissen fundoplication fails.

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

In the study, operative failure was defined as either recurrence of preoperative reflux symptoms or requirement of additional anti-reflux surgery.

The esophagogastric dissociation group had a 4% operative failure rate.

The Nissen fundoplication group had a 21% operative failure rate.

The difference in operative failure rates between esophagogastric dissociation and Nissen fundoplication was not statistically significant.

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

54% of patients in the Nissen fundoplication group continued to require anti-reflux medications after surgery.

The difference in continued requirement for anti-reflux medications between groups was statistically significant.

Caregiver-evaluated quality of life and symptom scores were the same between the esophagogastric dissociation and Nissen groups.

The lack of statistical significance in operative failure rates could represent a type 2 error where the sample size was too small to detect an actual difference.

The study examined perioperative factors including OR time, length of hospital stay, need for ICU stay, and time to full feeds, finding 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.