title: Laparoscopic gastric pull-up for long gap esophageal atresia.
abstract: BACKGROUND
  Esophageal replacement (ER) is indicated for long gap esophageal atresia (LGEA) when anastomosisis not possible, especially in cases without fistula or when elongation techniques have failed. The authors show their techniques and analyze preliminary results of the laparoscopic gastric pull-up (LGPU) for ERin LGEA.
  
  
  METHODS
  Four children with LGEA admitted for ER (three type A, one type C) underwent LGPU. Using three ports, including the gastrostomy site, surgical steps included releasing the stomach while preserving the right gastric and gastroepiploic arteries, pyloromyoplasty, and retromediastinal blunt dissection through a laparoscopic view. The esophagostomy was freed and the superior mediastinum was dissected, the stomach was pulled up for cervical anastomosis to the distal esophagus in two cases and to the gastric fundus in another two, adding thoracoscopy in two.
  
  
  RESULTS
  All operations were performed without major surgical complications, conversion, death, or reoperation.There were no abdominal complications. Two children presented atelectasis and one case evolved to pneumonia.A girl had a cervical fistula close spontaneously. Transanastomotic tube feeding began after 2-4 days,oral feeding after 8-12 days. Mild anastomotic stenosis (2) was resolved with endoscopic dilatations. After a follow-up of 9-26 months all children have functional grafts and satisfactory oral feeding. One child has duodeno-gastric reflux. Cosmetics have been excellent. The children have the same scars they had before (umbilicus,gastrostomy, and esophagostomy) plus a tiny 3 mm scar on the right flank.
  
  
  CONCLUSIONS
  Video-assisted esophageal replacement with the stomach for LGEA can be safely performed in children and infants, even after a previous mediastinal operation; however, larger comparative series are required in the future.
authors.affiliation: Pediatric Surgery Division, University of Goias, Goiania, Brazil. edward@doctor.com
authors.forename: Edward
authors.initials: E
authors.lastname: Esteves
authors.forename: Marcelo Calcagno
authors.initials: MC
authors.lastname: Silva
authors.forename: Kelly Cristina Castro
authors.initials: KC
authors.lastname: Paiva
authors.forename: Celio Carneiro
authors.initials: CC
authors.lastname: Chagas
authors.forename: Roneyara Rosa
authors.initials: RR
authors.lastname: Valamie
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Loiola de Guimaraes
authors.forename: Bernardina Barbosa Carvalho
authors.initials: BB
authors.lastname: Modesto
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications