title: Esophageal replacement in the neonatal period in infants with esophageal atresia and tracheoesophageal fistula.
abstract: OBJECTIVE
  The aim of the study was to assess the outcome after esophageal replacement using gastric pull-up performed in critically ill neonates with esophageal atresia (EA) and tracheoesophageal fistula.
  
  
  METHODS
  During 1998 to 2005, gastric transposition was performed in 27 neonates (mean birth weight, 2.32 kg [1.86-3.0 kg]; mean age, 6.08 days) for post-EA and tracheoesophageal fistula leaks in 17, long gap in 6, and pure EA in 4, using transhiatal route in all. Pyloromyotomy as the drainage procedure was added for all 27 neonates. Patients were followed up at 3, 6, and 12 months for clinical evaluation, gastric clearance, duodenogastric reflux, and gastric pressure profile.
  
  
  RESULTS
  Six neonates had ongoing serious chest infection, 3 had lung collapse, and 2 had associated congenital heart disease. Postoperative elective ventilation was provided to all neonates for 2 to 40 days (mean, 10.6 days). Nine neonates developed postoperative leaks in the neck; all healed spontaneously before discharge. Mean hospital stay was 32.6 days (range, 9-87 days). Four newborns died on postoperative days 9, 13, 15, and 29 because of existing severe sepsis in 3 and major congenital heart disease in 1. Functional evaluations were done at 3, 6, and 12 months postoperatively. Values at 6 months revealed normal gastric emptying in 16 of 23, presence of duodenal gastric reflux in 11 of 23, and mass contractions with significant rise in intragastric pressure after bolus feeds in 16 of 23 cases. Values at 12 months revealed normal gastric emptying in 14 of 20, presence of duodenal gastric reflux in 8 of 20, and mass contractions with significant rise in intragastric pressure after bolus feeds in 13 (65%) of 20 cases.
  
  
  CONCLUSIONS
  Gastric transposition could be a lifesaving alternative to diversion, even in the critically ill newborns after major leaks. However, it requires technical surgical expertise and an effective pain relief and neonatal intensive care.
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. devendra6@hotmail.com
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Gupta
authors.forename: Shilpa
authors.initials: S
authors.lastname: Sharma
authors.forename: Mahesh K
authors.initials: MK
authors.lastname: Arora
authors.forename: Gautam
authors.initials: G
authors.lastname: Agarwal
authors.forename: Malvika
authors.initials: M
authors.lastname: Gupta
authors.forename: Ved P
authors.initials: VP
authors.lastname: Grover
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005746:Gastric Emptying; D006801:Humans; D007231:Infant, Newborn; D013270:Stomach / Q000601:surgery; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery*