Partial gastric pull-up in the treatment of patients with long-gap esophageal atresia
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Partial gastric pull-up in the treatment of patients with long-gap esophageal atresia Marc Reismann, Tina Granholm, Henrik Ehrén Stockholm, Sweden Background: This study was to analyze outcomes of long-gap esophageal atresia (LGEA) treated with partial gastric pull-up (PGP) into the thorax.
Results: Nine children who had undergone PGP were followed up for a mean period of 6.2±3.1 years. Their median gestational age was 37+2 weeks, and mean birth weight 2462±658 g. Eight children were primarily treated with a gastrostomy, their mean age at PGP was 11.4±10.9 weeks and mean weight was 4484±1966 g. Their mean operation time was 199±51 minutes. Leakage was an early postoperative complication in three children, one of whom had a consecutive stricture resection. Late complications were stenosis (n=7) and gastro-esophageal reflux (n=5). The general status of the children was judged as "good" or "very good" on the last presentation. The median percentile of the body-mass-index was 25. Gastroscopy at 3.7±3.2 years after the operation revealed a grade I esophagitis in two children. There was no death in this group of children. Conclusions: Because of its high complication rate, partial gastric pull-up cannot be recommended as an alternative for the treatment of LGEA at present. A final judgment could be made on the basis of a comparative study. World J Pediatr November 2014; Online First Key words: early childhood; esophageal atresia; gastric pull-up
Author Affiliations: Department of Pediatric Surgery and Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden (Reismann M, Granholm T, Ehrén H) Corresponding Author: Marc Reismann, Department of Pediatric Surgery and Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinskavägen, 17176 Stockholm, Sweden (Email: [email protected]) doi: 10.1007/s12519-014-0523-8 ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2014. All rights reserved.
World J Pediatr, Online First, November 2014 . www.wjpch.com
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ejunal interposition (JI), colon interposition (CI) and gastric pull-up (GPU) are the most common surgical techniques for the treatment of long-gap esophageal atresia (LGEA).[1] However, there is still no consensus on the optimal treatment for this entity. This disagreement concerning the best treatment option is eventually due to lack of evidence. There are just very few prospective studies on gastric pull-up with a total of 37 patients.[2-4] Prospective comparative studies are lacking.[1] The current evidence suggests that none of these most common techniques represents the optimal treatment option. The morbidity of the patients using these techniques is significant. In the currently available studies, the need of reoperation is probably not sufficiently outlined, as mentioned in a recent meta-analysis.[1] Surgical treatment for LGEA using the stomach without interposition of the intestine is a classical method which is used since the 1940s.[5] With
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