DOZ047.37: 5-year follow-up after 17 laparoscopic transhiatal esophagectomy and gastric pull-up (TEGPUL)

Abstract

Abstract Background Survival in patients with EA. Materials and Methods Between 2011 and 2015, we performed 17 transhiatal esophagectomy and gastric pull-up (TEGPUL) in 8 girls and 9 boys, with a mean age 34 months (range: 8–99 months). All born with EA 65% (11) were acquired long-gap (EA type III, those where a primary anastomosis was initially achieved and then lost because of complications and redo surgeries) and 35% (6) congenital long-gap (EA types I and II). Immediate, mediate, and late complications were recorded. They were contacted by email, Facebook, instagram, and WhatsApp. WHO charts were used for nutritional diagnosis. Results Mean operating time 5.5 hours (3.5–8 hours), mean days of mechanical ventilation 4.5 (2–8 days), mean days of hospitalization 18 (9–40 days), mean time of oral feeding 12.5 days (3–30 days). We contacted 92% of the living patients. Immediate complications (first 14 postoperative days): 3 (18%) reoperative surgery (2 acute gastric obstruction and 1 incidental colon perforation); 3 (18%) patients had perioperative cardiac arrest (2 in-OR and 1 out-OR) all left but one, with neurological sequelae, died on the 12th postoperative day; 8 patients (47%) had a leak of the esophagogastric anastomosis, all health spontaneously in an average of 15 days and high blood pressure in 10 (59%) patients, unknown etiology. Mediate complications (from 15 postoperative days to 3 months): gastric emptying delay 3 (18%), GER 5 (29%), and recurrent lower respiratory infections 9 (53%). Late complications (from 3 months to 5 years): malnutrition 2 (18%), risk of malnutrition 3 (27%), diaphragmatic hernia 1 (9%), upper gastrointestinal bleeding 1 (9%). Postoperative parents satisfaction 100%. Conclusion TEGPUL is a safe and reproducible esophageal replacement technique in patients with long-gap EA, but have a long learning curve. However, more long-term and larger follow-up studies are needed, for which we recommend grouping these patients in a national reference center.