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Partial gastric pull-up in the treatment of patients with long-gap esophageal atresia
Marc Reismann, Tina Granholm, Henrik Ehr¨¦n
Stockholm, Sweden
Author Affiliations: Department of Pediatric Surgery and Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden (Reismann M, Granholm T, Ehr¨¦n H)
Corresponding Author: Marc Reismann, Department of Pediatric Surgery and Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinskavägen, 17176 Stockholm, Sweden (Email: marc.reismann@gmx.de)
doi: 10.1007/s12519-014-0523-8 Online First November 2014.
Background: This study was to analyze outcomes of long-gap esophageal atresia (LGEA) treated with partial gastric pull-up (PGP) into the thorax.
Methods: The medical records of all children who had undergone PGP for LGEA from 1999 to 2012 were reviewed. Preoperative data, initial postoperative course, complications, time to full oral nutrition, follow-up diagnostics and nutritional status were assessed.
Results: Nine children who had undergone PGP were followed up for a mean period of 6.2¡À3.1 years. Their median gestational age was 37+2 weeks, and mean birth weight 2462¡À658 g. Eight children were primarily treated with a gastrostomy, their mean age at PGP was 11.4¡À10.9 weeks and mean weight was 4484¡À1966 g. Their mean operation time was 199¡À51 minutes. Leakage was an early postoperative complication in three children, one of whom had a consecutive stricture resection. Late complications were stenosis (n=7) and gastro-esophageal refl ux (n=5). The general status of the children was judged as "good" or "very good" on the last presentation. The median percentile of the body-mass-index was 25. Gastroscopy at 3.7¡À3.2 years after the operation revealed a grade I esophagitis in two children. There was no death in this group of children.
Conclusions: Because of its high complication rate, partial gastric pull-up cannot be recommended as an alternative for the treatment of LGEA at present. A final judgment could be made on the basis of a comparative study.
World J Pediatr 2015;11(3):267-271
Key words: early childhood; esophageal atresia; gastric pull-up
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