Document Detail


Total esophagogastric dissociation: an alternative approach.
MedLine Citation:
PMID:  9314245     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
A Bianchi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  32     ISSN:  0022-3468     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  1997 Sep 
Date Detail:
Created Date:  1997-10-30     Completed Date:  1997-10-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1291-4     Citation Subset:  IM    
Affiliation:
The Royal Manchester Children's Hospital, England.
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Roux-en-Y / methods
Child
Child, Preschool
Esophagus / surgery*
Follow-Up Studies
Fundoplication
Gastroesophageal Reflux / surgery*
Gastrostomy
Humans
Infant
Jejunostomy / methods*
Jejunum / surgery*
Patient Care Planning
Prognosis
Recurrence
Treatment Failure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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