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Functional outcome after laparoscopic assisted gastric transposition including pyloric dilatation in long-gap esophageal atresia.
J Pediatr Surg. 2020 Jun 13 [Online ahead of print]JP

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.

Authors+Show Affiliations

Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany. Electronic address: justus.lieber@med.uni-tuebingen.de.Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany.Department of Pediatric Cardiology, Pulmonology, and Intensive Care Medicine, University Children's Hospital, Tübingen, Germany.Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany.Department of Diagnostic Radiology, University Hospital, Tübingen, Germany.Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany.Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32646666

Citation

Lieber, Justus, et al. "Functional Outcome After Laparoscopic Assisted Gastric Transposition Including Pyloric Dilatation in Long-gap Esophageal Atresia." Journal of Pediatric Surgery, 2020.
Lieber J, Schmidt A, Kumpf M, et al. Functional outcome after laparoscopic assisted gastric transposition including pyloric dilatation in long-gap esophageal atresia. J Pediatr Surg. 2020.
Lieber, J., Schmidt, A., Kumpf, M., Fideler, F., Schäfer, J. F., Kirschner, H. J., & Fuchs, J. (2020). Functional outcome after laparoscopic assisted gastric transposition including pyloric dilatation in long-gap esophageal atresia. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2020.06.004
Lieber J, et al. Functional Outcome After Laparoscopic Assisted Gastric Transposition Including Pyloric Dilatation in Long-gap Esophageal Atresia. J Pediatr Surg. 2020 Jun 13; PubMed PMID: 32646666.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional outcome after laparoscopic assisted gastric transposition including pyloric dilatation in long-gap esophageal atresia. AU - Lieber,Justus, AU - Schmidt,Andreas, AU - Kumpf,Matthias, AU - Fideler,Frank, AU - Schäfer,Jürgen F, AU - Kirschner,Hans-Joachim, AU - Fuchs,Jörg, Y1 - 2020/06/13/ PY - 2019/10/07/received PY - 2020/04/21/revised PY - 2020/06/04/accepted PY - 2020/7/11/entrez KW - Gastric transposition KW - Infants and children KW - Laparoscopy KW - Long-gap esophageal atresia KW - Minimal invasive surgery KW - Replacement therapy JF - Journal of pediatric surgery JO - J. Pediatr. Surg. N2 - 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. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/32646666/Functional_outcome_after_laparoscopic_assisted_gastric_transposition_including_pyloric_dilatation_in_long-gap_esophageal_atresia L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(20)30416-4 DB - PRIME DP - Unbound Medicine ER -
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