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Laparoscopically assisted gastric pull-up for long gap esophageal atresia
Benno M Ure1, Natalie K Jesch, Robert Sümpelmann
1Department of Pediatric Surgery Hannover Medical School, Hannover, Germany.
Background:
Laparoscopically assisted gastric pull-up procedure has been performed in adults for various conditions. The authors report the first patient, who underwent laparoscopically assisted esophageal replacement for long gap esophageal atresia.
Methods:
The patient had Down's syndrome and long gap esophageal atresia without fistula. A gastrostomy was performed right after birth, and a suction drain was positioned in the upper esophageal pouch. Esophageal replacement took place at the age of 3 months. The laparoscopic operation included complete mobilization of the stomach, resection of the lower esophageal stump (Endo-GIA), pyloroplasty, and transhiatal dissection. After a right cervical approach, the gastric pull-up was performed through the posterior mediastinum, and the upper anastomosis was completed. Finally, a laparoscopic jejunostomy was performed.
Results:
The duration of the operation was 4.5 hours. The intra- and postoperative courses were uneventful. Feeding via the jejunostomy was started on day 1. Gastric emptying of contrast media was documented by x-ray examination. Oral feeding was started on day 8 and is now, 3 months postoperative, well tolerated.
Conclusions:
This is the first report on laparoscopically assisted gastric pull-up for long gap esophageal atresia. The technique represents an option for the treatment of long gap esophageal atresia.
