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Updated: Jun 4, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Minimally invasive esophagectomy and gastric pull-up in children
Deiadra Garrett1, Dean Anselmo, Henri Ford
1Department of Pediatric Surgery, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA 90027, USA. djgarre@aol.com
Insights
Minimally invasive esophagectomy and gastric pull-up is a safe and feasible procedure for pediatric patients with esophageal issues. This approach shows promising outcomes, though further research is needed for validation.
Area of Science:
- Pediatric surgery
- Thoracic surgery
- Minimally invasive surgery
Background:
- Minimally invasive esophagectomy and gastric pull-up is established in adults but less explored in pediatric cases.
- This study evaluates a novel approach for pediatric esophageal reconstruction.
Observation:
- Three pediatric patients (average age 46 months) underwent minimally invasive esophagectomy and gastric pull-up for esophageal stricture or atresia.
- The procedure involved an average operative time of 7 hours with minimal blood loss.
Findings:
- No intraoperative complications or immediate anastomotic leaks were observed.
- Postoperative complications included one wound infection, one anastomotic stricture treated with dilatation, and one delayed leak that resolved spontaneously.
- All patients achieved excellent weight gain and tolerated regular food at follow-up.
Implications:
- Minimally invasive esophagectomy and gastric pull-up is a technically feasible and safe option for pediatric esophageal reconstruction.
- The procedure demonstrates acceptable short-term outcomes in children.
- Further investigation is warranted to confirm the long-term efficacy and validate this minimally invasive technique in pediatric populations.
Purpose:
Minimally invasive esophagectomy and gastric pull-up is a widely accepted method in adults. However, the experience in the pediatric population is limited. Minimally invasive esophagectomy represents a new alternative technique to the conventional open approach. We wish to report our small case series of minimally invasive esophagectomy and gastric pull-up in pediatric patients. The aim of the study is to evaluate the feasibility, safety, and outcomes of the procedure.
Methods:
Three patients (2 girls and 1 boy) with average age 46 months (34-57 months) and average weight 12.6 kg (11-15 kg) underwent the procedure. The indications for esophagectomy were esophageal stricture from caustic ingestion (2 patients) and failed repair of esophageal atresia (1 patient).
Results:
Average operative time was 7 h (0519-0752 hours). There were no intraoperative complications with the average blood loss of 50 cc (5-125 cc). No anastomotic leaks were noted on the initial esophagrams that were obtained on postoperative day five or six. One patient developed a cervical wound infection on postoperative day seven due to a retained piece of Penrose, which required a neck exploration, removal of foreign body and repair of a small leak. One patient developed an anastomotic stricture at the 7-month follow-up. She was successfully treated with two balloon dilatations. One patient developed a delayed esophagogastric anastomotic leak at 3 months. The leak spontaneously closed after surgical drainage. At average of 22-month follow-up (15-36 months), all patients were eating regular food with excellent weight gain.
Conclusion:
Minimally invasive esophagectomy and gastric pull-up is technically challenging but feasible and safe with acceptable outcomes. However, further study is needed to further validate the approach.
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