Neonatal gastric pull up: reality or myth?

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Gastroenterology

Background:

• Esophageal atresia and tracheoesophageal fistula (EATEF) often necessitates complex surgical management.
• Primary repair failure or non-feasibility in neonates leads to the need for esophageal substitution.
• Limited return rates for staged esophageal replacement prompted the evaluation of alternative single-stage procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of single-stage esophageal replacement using gastric pull-up in neonates with EATEF.
• To assess the functional outcomes, including gastric emptying and reflux, following this procedure.
• To determine the morbidity and mortality associated with gastric pull-up in this high-risk population.

Main Methods:

• Retrospective review of 12 full-term neonates undergoing gastric pull-up for EATEF between 1998 and 2000.
• Indications included major leaks post-primary repair, pure esophageal atresia, and wide esophageal gaps.
• Postoperative evaluation included colloid radiopharmaceutical scans, HIDA scans for duodenogastric reflux (DGR), and contrast studies for gastric transit.

Main Results:

• Three patients experienced minimal neck site leaks that healed successfully.
• Postoperative evaluations revealed gastric emptying obstruction in 1 case and duodenogastric reflux in 25% of cases.
• Mortality was 16% (2 deaths), attributed to congenital cardiac disease and septicemia, respectively.

Conclusions:

• Single-stage gastric pull-up offers an acceptable morbidity, mortality, and functional outcome for neonates requiring esophageal replacement.
• This procedure is recommended when primary repair of EATEF fails or is not feasible in the neonatal period.
• Further evaluation of gastric function and reflux is essential in long-term follow-up.