Functional outcome after laparoscopic assisted gastric transposition including pyloric dilatation in long-gap esophageal atresia
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In brief
In brief
This case series reports functional outcomes in 14 children with long-gap esophageal atresia treated with laparoscopic-assisted gastric transposition and pyloric dilatation. At median 60-month follow-up, all patients achieved patent GI tracts with normal weight gain and feeding without dumping or reflux, demonstrating good functional results with this minimally invasive approach.
Written by the GCMD Library team from the article.
Abstract
Background/Purpose
Among the options for esophageal replacement in long-gap esophageal atresia (LGEA), gastric transposition (GT) is accessible for an endoscopic approach. Here we report a novel technique and functional results after laparoscopic-assisted gastric transposition (LAGT), including pyloric dilatation in patients with LGEA.
Methods
Retrospective analysis of 14 children undergoing LAGT. Surgical steps included the release of the gastrostomy, transumbilical ante-situ section of the stomach including pyloric balloon-dilation, and laparoscopically controlled transhiatal retromediastinal blunt dissection followed by LAGT for cervical anastomosis to the proximal esophagus.
Results
The median age at LAGT was 110 days (33–327 days), bodyweight 5.3 kg (3.1–8.3 kg). Operation time was 255 min (180–436 min); one conversion was necessary. The duration of ventilation was 4 days (1–14 days). Postpyloric feeding was started after 2 days, and oral feeding after 13 days. Complications were recurrent pleural effusion or pneumothorax and transient Horner syndrome or transient incomplete paresis of the recurrence nerve. After a median follow-up of 60 months (13–240 months), all children have a patent upper GI tract, show weight gain, and are fed without delayed gastric emptying, dumping, or reflux. Severe (n = 1) or mild (n = 2) anastomotic or pyloric (n = 5) stenosis was resolved with endoscopic dilatations.
Conclusions
Functional outcome after LAGT in patients with LGEA is good. The laparoscopic retromediastinal dissection preserves thoracal structures and increases patients' safety. The technique of pyloric dilatation might also prevent dumping syndrome.
Type of Study
Case Series with no Comparison Group.
Level of Evidence
Level IV.