Surgical Management of Gastroesophageal Reflux in Neurologically Impaired Children: Fundoplication vs. Total Esophagogastric Dissociation

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Abstract
Background: Gastroesophageal reflux disease (GERD) is a prevalent and severe condition in neurologically impaired (NI) children, often requiring surgical intervention. This study evaluates the outcomes of two surgical techniques, fundoplication and total esophagogastric dissociation (EGD), in managing GERD in this vulnerable population. Methods: We conducted a retrospective analysis of 56 NI children who underwent surgery for GERD at our institution from 2012 to 2023. Outcomes assessed included post-operative weight gain, pneumonia rates, hospitalization duration, and complications. Results: Of the cohort, 39 patients underwent fundoplication and 17 underwent EGD. Both groups experienced significant weight gain post-operatively, with comparable rates between procedures. Fundoplication was associated with shorter hospitalization (16 ± 10 days vs. 35 ± 16 days, p < 0.001) and earlier resumption of enteral feeding (5.5 ± 2 days vs. 10.2 ± 3 days). EGD significantly reduced pneumonia rates (70.59% to 17.65%, p = 0.006) compared to fundoplication (58.97% to 41.03%, p = 0.174). Early complication rates were higher in the EGD group (41% vs. 23%), but long-term GERD-related hospitalizations were fewer (0.8 ± 1/year vs. 3 ± 2/year, p = 0.003). Conclusions: Fundoplication offers shorter recovery times and lower early complication rates, making it suitable for many patients. However, EGD may be preferable for those with severe, refractory GERD, given its superior long-term outcomes, particularly in reducing pneumonia and hospitalizations. Prospective studies are needed to confirm these findings and refine surgical indications in NI children.

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