Primary gastric pull-up in pure esophageal atresia: technique, feasibility and outcome. A prospective observational study

Abstract

To perform a definitive procedure in pure esophageal atresia by gastric pull-up in the newborn. A primary gastric pull-up was performed in six newborns with pure esophageal atresia that presented between 1998 and 2009. The cervical esophagus was mobilized through the neck, the stomach was mobilized through laparotomy, the left gastric artery was ligated, and Pyloromyotomy was done. The stomach was brought into the neck via the trans hiatal route. A single-layer esophageo-gastric anastomosis was done in the neck in all. The mean birth weight was 2.1 kg (range 1.9-2.7) and the age at surgery varied from 3 to 7 days (mean 4.5 days). The mean operative time was 146 min. All six neonates received postoperative elective ventilation for a period of 2-7 days (mean 5.3). Epidural morphine was given for postoperative pain relief. Four received TPN for 5-13 days. Three had minor leaks from the neck wound that healed spontaneously. Mean hospital stay was 14.6 with a range 13-20 days. There was no mortality. It is feasible to perform the gastric pull-up for long gap esophageal atresia in the newborn period, as a definitive procedure with no added risks to life in experienced hands.