title: Tubularized Gastric Conduit is More Desirable in Pediatric Patients Treated with Minimally Invasive Esophagectomy and Gastric Pull-Up.
abstract: BACKGROUND
  Conditions requiring an esophagectomy and esophageal replacement are rare in children. The preferred method and ideal replacement organ continue to be debated. We present long-term outcomes in children treated with esophagectomy and gastric pull-up.
  
  
  METHODS
  We conducted a retrospective review of all the patients who underwent a esophagectomy and gastric pull-up at two major pediatric institutions from 2004 to 2015. Follow-up data were obtained for children when available, including any postoperative complications, need for dilation of strictures, and current feeding method.
  
  
  RESULTS
  Minimally invasive procedures were performed on 7 patients (5 female and 2 male) with a median age of 3 years (range 2-20, standard deviation = 8). Three patients successfully underwent laparoscopic transhiatal esophagectomy and cervical gastric pull-up, and three patients successfully underwent combined laparoscopic and right thoracoscopic (Ivor-Lewis) esophagectomy and cervical gastric pull-up. We identified an additional 3 patients who had an open esophagectomy and gastric pull-up. Seven patients had tubularized gastric conduits, six without pyloroplasty and one with pyloroplasty. For those patients with tubularized conduits, the average time to achieve full oral feeds was 16 days, with 1 patient with pyloroplasty who took 27 days. Of the three whole-stomach conduits, one reached oral independence at 19 days and the other two had yet tolerated anything per os. Follow-up data were available for all patients. At the average 5 years follow-up (ranging from 1 month to 7 years), all but two were thriving well with full oral feeds.
  
  
  CONCLUSIONS
  Minimally invasive esophagectomy and gastric pull-up is a good alternative in managing pediatric patients in need of esophagectomy and replacement; it offers acceptable early and long-term outcomes. Tubularized conduit appears to be superior to using the whole stomach and potentially avoids pyloroplasty. Ongoing study is needed to validate our findings.
authors.affiliation: 1 Department of Surgery, Children's Hospital Los Angeles , Los Angeles, California.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Castle
authors.affiliation: 1 Department of Surgery, Children's Hospital Los Angeles , Los Angeles, California.
authors.forename: Mubina
authors.initials: M
authors.lastname: Isani
authors.affiliation: 1 Department of Surgery, Children's Hospital Los Angeles , Los Angeles, California.|2 Department of Surgery, Miller Children's Hospital, Long Beach Memorial Medical Center , Long Beach, California.
authors.forename: Manuel B
authors.initials: MB
authors.lastname: Torres
authors.affiliation: 1 Department of Surgery, Children's Hospital Los Angeles , Los Angeles, California.|2 Department of Surgery, Miller Children's Hospital, Long Beach Memorial Medical Center , Long Beach, California.
authors.forename: Dean M
authors.initials: DM
authors.lastname: Anselmo
authors.affiliation: 1 Department of Surgery, Children's Hospital Los Angeles , Los Angeles, California.|2 Department of Surgery, Miller Children's Hospital, Long Beach Memorial Medical Center , Long Beach, California.
authors.forename: Nam X
authors.initials: NX
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D002057:Burns, Chemical / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004931:Esophageal Achalasia / Q000601:surgery; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000151:congenital / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009333:Neck; D011183:Postoperative Complications / Q000453:epidemiology; D011708:Pylorus / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D055815:Young Adult
keywords: esophagectomy; esophagus; gastric pull-up