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Congenital intrathoracic stomach can be safely managed laparoscopically
Alisha Gupta1, Bushra Zia1, Dhanya Mullassery1
1Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
Insights
Congenital intrathoracic stomach (CIS) in children is rare but treatable. Laparoscopic surgery offers a safe and effective solution with a low recurrence rate for this condition.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Thoracic Surgery
Background:
- Congenital intrathoracic stomach (CIS) is a rare pediatric condition where a significant portion of the stomach herniates into the chest.
- This condition requires surgical intervention to correct the hiatus defect and reposition the stomach.
Purpose of the Study:
- To review the experience with congenital intrathoracic stomach in children.
- To evaluate the efficacy and outcomes of laparoscopic management for CIS.
Main Methods:
- A retrospective review of pediatric patients diagnosed with CIS between 2007 and 2018.
- Assessment of patient demographics, clinical presentation, imaging findings, surgical management (laparoscopic repair, fundoplication, gastrostomy), and follow-up outcomes.
Main Results:
- Eleven pediatric patients (6 female) with CIS were identified, presenting with symptoms like vomiting and respiratory issues.
- All patients underwent successful laparoscopic correction, including hiatus repair and fundoplication, with a median age of 10.5 months at surgery.
- Post-operative recovery was favorable, with all patients achieving full enteral feeds; one recurrence was successfully managed with repeat laparoscopy.
Conclusions:
- This study represents the largest reported series of pediatric congenital intrathoracic stomach cases.
- Laparoscopic management is a safe and effective approach for CIS in children, associated with a low rate of recurrence and no need for conversion to open surgery.
Purpose:
Congenital intrathoracic stomach (CIS) is an uncommon pediatric surgical diagnosis where > 2/3rd of the stomach lies within the chest through a hiatus defect. We reviewed our recent experience with this condition.
Methods:
A retrospective single-center review of children with a diagnosis of CIS (2007-2018) was performed. Patient demographics, presentation, imaging and management were assessed. Results are expressed as median (range).
Results:
Eleven patients (6 girls) were identified with onset of symptoms at 2 (0-26) months of age. Presenting symptoms were vomiting (8/11), respiratory symptoms (4/11) and failure to thrive (2/11). Two patients had Marfan's syndrome. An upper gastrointestinal contrast study demonstrated gastric herniation in all. All were corrected laparoscopically with hiatus repair and fundoplication [age at surgery 10.5 (1.5-34.5) months]. A concurrent gastrostomy was done in children ≤ 6 months (n = 5). Enteral feeds were commenced on post-operative day one in 9 and second post-operative day in 2. At 7 (0-95) months follow-up, all were on full enteral feeds. One patient had a recurrence 6 months post-operatively, which was re-operated laparoscopically without any further recurrence.
Conclusion:
This is the largest reported series of children with CIS. All could be managed laparoscopically with no conversions and a low recurrence.
