Primary gastric pull-up in pure esophageal atresia: technique, feasibility and outcome. A prospective observational study.
OBJECTIVE
To perform a definitive procedure in pure esophageal atresia by gastric pull-up in the newborn.


METHODS
A primary gastric pull-up was performed in six newborns with pure esophageal atresia that presented between 1998 and 2009. The cervical esophagus was mobilized through the neck, the stomach was mobilized through laparotomy, the left gastric artery was ligated, and Pyloromyotomy was done. The stomach was brought into the neck via the trans hiatal route. A single-layer esophageo-gastric anastomosis was done in the neck in all.


RESULTS
The mean birth weight was 2.1 kg (range 1.9-2.7) and the age at surgery varied from 3 to 7 days (mean 4.5 days). The mean operative time was 146 min. All six neonates received postoperative elective ventilation for a period of 2-7 days (mean 5.3). Epidural morphine was given for postoperative pain relief. Four received TPN for 5-13 days. Three had minor leaks from the neck wound that healed spontaneously. Mean hospital stay was 14.6 with a range 13-20 days. There was no mortality.


CONCLUSIONS
It is feasible to perform the gastric pull-up for long gap esophageal atresia in the newborn period, as a definitive procedure with no added risks to life in experienced hands.
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
Shilpa
S
Sharma
Devendra K
DK
Gupta
D000714:Anastomosis, Surgical / Q000379:methods; D004933:Esophageal Atresia / Q000175:diagnosis / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome
J Pediatr Surg. 1994 Apr;29(4):487-91
8014799
J Pediatr Surg. 2004 Mar;39(3):276-81; discussion 276-81
15017537
J Pediatr Surg. 1980 Jun;15(3):303-9
7381664
Cir Pediatr. 2003 Jul;16(3):112-5
14565089
Pediatr Surg Int. 1996 Apr;11(4):218-20
24057620
Pediatr Surg Int. 2003 Apr;19(1-2):100-3
12721737
Eur J Pediatr Surg. 1997 Jun;7(3):143-6
9241498
Semin Pediatr Surg. 2009 Feb;18(1):30-3
19103419
Pediatr Surg Int. 1996 Apr;11(4):227-9
24057623
J Pediatr Surg. 2007 Sep;42(9):1471-7
17848233
Pediatr Surg Int. 2004 Jun;20(6):415-8
15095101
J Pediatr Surg. 1996 Apr;31(4):588-93
8801320