title: A two-center comparative study of gastric pull-up and jejunal interposition for long gap esophageal atresia.
abstract: OBJECTIVE
  When restoration of the anatomical continuity in case of long gap esophageal atresia (LGEA) is not feasible, esophageal replacement surgery becomes mandatory. The aim of this paper is to critically compare the experience of two tertiary referral centers in The Netherlands performing either gastric pull-up (GPU) or jejunal interposition (JI).
  
  
  METHODS
  Retrospective chart review of all the patients with LGEA who underwent GPU in the University Medical Center Groningen and JI in the University Medical Center Utrecht. Main endpoints were short term morbidity, mortality and long term functional outcome (digestive functioning and growth). Descriptive analyses conducted using Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables.
  
  
  RESULTS
  Nine children underwent GPU and 15 JI. Median age (years) at last follow up was fourteen (GPU) and eight (JI). One patient died, 10 years after JI. No grafts were lost. Perioperative anastomotic complications were reported more often after JI (73% vs. 22%, p=0.03). However reintervention rate was the same in both groups (33%). Among long term outcomes, functional obstruction was not registered after GPU, while it was recorded in 46% after JI (p=0.02). No other significant differences were found apart from some tendencies concerning full oral nutrition and gastroesophageal reflux (GPU>JI).
  
  
  CONCLUSIONS
  Comparative data from this study reveal no mortality but significant morbidity in both groups. No graft was lost. Although not statistically different as a result of small patient numbers, clinically important differences regarding gastrointestinal system were noted. Growth should be monitored closely in both groups.
authors.affiliation: Department of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: g.gallo@umcg.nl.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Gallo
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Sander
authors.initials: S
authors.lastname: Zwaveling
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: David C
authors.initials: DC
authors.lastname: Van der Zee
authors.affiliation: Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Klaas N
authors.initials: KN
authors.lastname: Bax
authors.affiliation: Department of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Zacharias J
authors.initials: ZJ
authors.lastname: de Langen
authors.affiliation: Department of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jan B F
authors.initials: JB
authors.lastname: Hulscher
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D004933:Esophageal Atresia / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D055815:Young Adult
keywords: Esophageal Atresia; Esophageal replacement; Gastric pull-up; Gastric transposition; Jejunal interposition; Long-gap