title: Respiratory function after esophageal replacement in children.
abstract: BACKGROUND
  Children born with esophageal atresia require an anastomosis between the proximal and distal esophagus. When this distance is too wide (long gap esophageal atresia, LGEA) esophageal replacement strategies have to be deployed. The aim of this study was to assess long-term respiratory morbidity and lung function after esophageal replacement with either stomach (gastric pull-up, GPU) or jejunum (jejunal interposition, JI) for LGEA.
  
  
  METHODS
  Retrospective cohort study. Patients operated with GPU and JI for LGEA (1985-2007) underwent a semi-structured interview and lung function testing (LFT).
  
  
  RESULTS
  Seven GPU-patients and eight JI-patients were included. Median age was 12years. One patient per group could not perform LFT. Respiratory symptoms were reported by 13/15 patients (7/7 GPU-patients vs 6/8 JI-patients). All LFT items were lower than reference values; 6/13 patients showed restriction and 6/13 obstruction. All six GPU-patients had abnormal TLC and/or FEV1/FVC vs 3/7 after JI. Restriction was noted in 4/6 GPU-patients vs 2/7 JI-patients.
  
  
  CONCLUSIONS
  After esophageal replacement for LGEA many children have impaired lung function and respiratory symptoms are common. Lung volumes seem decreased after GPU compared to JI. This may be caused by the intrathoracic stomach which may limit normal lung growth. Respiratory follow-up in adult life is important after esophageal replacement.
  
  
  METHODS
  III.
authors.affiliation: University Medical Center Groningen, Pediatric Surgery, Groningen, the Netherlands. Electronic address: g.gallo@umcg.nl.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Gallo
authors.affiliation: Beatrix Children's Hospital, University Medical Center Groningen, Pediatric Pulmonology, Groningen, the Netherlands.
authors.forename: Elianne J L E
authors.initials: EJLE
authors.lastname: Vrijlandt
authors.affiliation: Wilhelmina Children's Hospital, University Medical Center Utrecht, Pediatric Pulmonology, Utrecht, the Netherlands.
authors.forename: Hubertus G M
authors.initials: HGM
authors.lastname: Arets
authors.affiliation: Beatrix Children's Hospital, University Medical Center Groningen, Pediatric Pulmonology, Groningen, the Netherlands.
authors.forename: Gerard H
authors.initials: GH
authors.lastname: Koppelman
authors.affiliation: Wilhelmina Children's Hospital, University Medical Center Utrecht, Pediatric Surgery, Utrecht, the Netherlands.
authors.forename: David C
authors.initials: DC
authors.lastname: Van der Zee
authors.affiliation: University Medical Center Groningen, Pediatric Surgery, Groningen, the Netherlands.
authors.forename: Jan B F
authors.initials: JBF
authors.lastname: Hulscher
authors.affiliation: Academic Medical Center Amsterdam, Pediatric Surgery, Amsterdam, the Netherlands.
authors.forename: Sander
authors.initials: S
authors.lastname: Zwaveling
mesh_terms: D000714:Anastomosis, Surgical; D004933:Esophageal Atresia / Q000601:surgery*; D004944:Esophagoplasty / Q000009:adverse effects* / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D011183:Postoperative Complications; D012140:Respiratory Tract Diseases / Q000209:etiology*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D014797:Vital Capacity
keywords: Esophageal atresia; Esophageal replacement; Long gap; Respiratory function