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Transhiatal gastric transposition of a long gap esophageal atresia
1Department of Pediatric Surgery, Yonsei University College of Medicine, Seoul, Korea.
Insights
Transhiatal gastric transposition offers a safe and effective surgical solution for long gap esophageal atresia. This procedure allows for early oral feeding with low morbidity in infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Long gap esophageal atresia without tracheoesophageal fistula presents significant surgical challenges for esophageal replacement.
- Traditional methods may involve higher morbidity or complex reconstructions.
Observation:
- A 12-month-old female infant with a history of gastrostomy underwent transhiatal gastric transposition for long gap esophageal atresia.
- The surgical technique involved mobilizing the stomach while preserving key arteries and the spleen, followed by excision of esophageal pouches and anastomosis in the neck.
Findings:
- The transhiatal gastric transposition procedure was successfully completed with a single esophagogastrostomy anastomosis in the neck.
- No anastomotic leaks or early strictures were observed, and the patient achieved rapid oral feeding.
- The infant showed no signs of regurgitation, gastric emptying issues, hoarseness, or respiratory problems post-operatively.
Implications:
- Transhiatal gastric transposition demonstrates low morbidity and satisfactory functional outcomes for esophageal replacement in this complex pediatric condition.
- This technique presents a safe and accessible alternative surgical option for managing long gap esophageal atresia.
Abstract:
Transhiatal gastric transposition was performed in a long gap esophageal atresia without tracheoesophageal fistula. The patient was a 12 months old female infant with previous stamm-type gastrostomy. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal blind pouches of esophagus were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up into the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was safely performed in the neck. There were neither anastomotic leak nor early anastomotic stricture. The oral feeding was quickly established. There was no clinical evidence of regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. The low morbidity combined with satisfactory functional result indicates that the transhiatal gastric transposition is a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.