Laparoscopically assisted gastric pull-up for long gap esophageal atresia.

BACKGROUND

Laparoscopically assisted gastric pull-up procedure has been performed in adults for various conditions. The authors report the first patient, who underwent laparoscopically assisted esophageal replacement for long gap esophageal atresia.

METHODS

The patient had Down's syndrome and long gap esophageal atresia without fistula. A gastrostomy was performed right after birth, and a suction drain was positioned in the upper esophageal pouch. Esophageal replacement took place at the age of 3 months. The laparoscopic operation included complete mobilization of the stomach, resection of the lower esophageal stump (Endo-GIA), pyloroplasty, and transhiatal dissection. After a right cervical approach, the gastric pull-up was performed through the posterior mediastinum, and the upper anastomosis was completed. Finally, a laparoscopic jejunostomy was performed.

RESULTS

The duration of the operation was 4.5 hours. The intra- and postoperative courses were uneventful. Feeding via the jejunostomy was started on day 1. Gastric emptying of contrast media was documented by x-ray examination. Oral feeding was started on day 8 and is now, 3 months postoperative, well tolerated.

CONCLUSIONS

This is the first report on laparoscopically assisted gastric pull-up for long gap esophageal atresia. The technique represents an option for the treatment of long gap esophageal atresia.