title: Pediatric esophageal substitution by gastric pull-up and gastric tube.
abstract: OBJECTIVE
  The aim of this study was to report the results of pediatric esophageal substitution by gastric pull-up (GPU) and gastric tube (GT) from a tertiary care pediatric center.
  
  
  METHODS
  Retrospective analysis of the surgical techniques, results, complications, and final outcome of all pediatric patients who underwent esophageal substitution in a single institution was performed.
  
  
  RESULTS
  Twenty-four esophageal substitutions were performed over 15-year period. The indications were pure esophageal atresia (EA)-19, EA with distal trachea-esophageal fistula-2, EA with proximal pouch fistula-1, and esophageal stricture in two patients. Mean age and weight at operation were 17 months and 9.5 kg, respectively. GPU was the most common procedure (19) followed by reverse GT (4) and gastric fundal tube (1). Posterior mediastinal and retrosternal routes were used in 17 and 7 cases, respectively. Major complications included three deaths in GPU cases resulting from postoperative tachyarrhythmias leading to cardiac arrest, cervical anastomotic leak-17, and anastomotic stricture in six cases. Perioperative tachyarrhythmias (10/19) and transient hypertension (2/19) were observed in GPU patients, and they were managed with beta blocker drugs. Postoperative ventilation in Intensive Care Unit was performed for all GPU, but none of the GT patients. Follow-up ranged from 6 months to 15 years that showed short-term feeding difficulties and no major growth-related problems.
  
  
  CONCLUSIONS
  Perioperative tachyarrhythmias are common following GPU which mandates close intensive care monitoring with ventilation and judicious use of beta blocking drugs. Retrosternal GT with a staged neck anastomosis can be performed without postoperative ventilation.
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Subhasis Roy
authors.initials: SR
authors.lastname: Choudhury
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Partap Singh
authors.initials: PS
authors.lastname: Yadav
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Niyaz Ahmed
authors.initials: NA
authors.lastname: Khan
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Shalu
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Pinaki Ranjan
authors.initials: PR
authors.lastname: Debnath
authors.affiliation: Department of Paediatric Intensive Care, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Virendra
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chadha
keywords: Esophageal substitution; gastric pull-up; gastric tube; tachyarrhythmias