Oesophagogastric Disconnection: Who, How and When? A Review Article

Severe Gastro-oesophageal reflux disease (GORD) is a disabling condition, causing significant morbidity and mortality. Fundoplication has long been seen as the gold standard operative solution, but in 5-43% of patients it will fail. Oesophagogastric disconnection or dissociation (OGD) is a relatively new procedure used for severe GORD. With this review we look at the current literature on the indications and outcomes after oesophagogastric disconnection; focusing on which patients are undergoing OGD and whether it is being performed as a primary or secondary operation. Articles were found using Scirus and Pubmed as search engines, with (o)esophagogastric disconnection/ dissociation/ separation (OGD) as keywords. Ten relevant papers were found; from Bianchi's original paper in 1997, to the most recent and largest two-centre study published in 2006. In total the papers include 158 patients undergoing OGD. Two of the papers set out to compare fundoplication vs OGD; two set out to compare the procedure as a primary vs secondary operation; the remaining 6 give information on their outcomes after OGD. All ten papers show how OGD is beneficial to patients severely affected by GORD. The results suggest that the morbidity and mortality, length of stay and post operative recovery of the operation is not significantly worse than for fundoplication. In those with severe neurological impairment and significant co-morbidities the outcome after OGD can be better than after fundoplication. The majority of the authors would consider OGD as a primary operation in severely neurologically impaired children, but realise that it has its risks and limitations.