title: Laparoscopic transhiatal esophagectomy and gastric pull-up in long-gap esophageal atresia: description of the technique in our first 10 cases.
abstract: The definition accepted for the largely controversial and multiple criteria condition known as long-gap esophageal atresia (LGEA) is "inability to achieve primary end-to-end anastomosis," particularly in the presence of a tracheo-esophageal fistula. In this article we report our technique of laparoscopic transhiatal esophagectomy and gastric pull-up (TEGPUL) in LGEA, based on the open approach of Spitz. Differences between TEGPUL and the original technique are the absence of a pyloromyotomy, the peel-away technique, the gastric pull-up through the distal esophagus, and its extracorporeal section. We performed the technique in 10 patients: 6 girls and 4 boys. Six had esophageal atresia type III (60%), three had esophageal atresia type I (30%) and one had esophageal atresia type II (10%). Mean time in surgery was 4.43 hours (range, 3.3-7 hours). Average stay in the pediatric intensive care unit was 5.9 days (range, 3-25 days). Average time under mechanical ventilation was 4.6 days (range, 2-8 days). Average total hospital stay was 19.4 days (range, 11-40 days). Oral feeding began at 15.6 days (range, 5-30 days). We believe these steps and the early realization of the technique will reduce the morbidity and mortality among these patients and decrease the number of contraindications to gastric pull-up. Nevertheless, a valid conclusion will require more studies with a larger number of patients and longer follow-up.
authors: Clinical Hospital of Caracas , Caracas, Venezuela .
authors: Alejandra
authors: A
authors: Parilli
authors: Wilfredo
authors: W
authors: García
authors: José Gregorio
authors: JG
authors: Mejías
authors: Ivet
authors: I
authors: Galdón
authors: Gregory
authors: G
authors: Contreras
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D007582:Jejunostomy; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome