Results of gastric pull-up procedure in neonatal long-gap esophageal atresia: a single center prospective study

Saeid Aslanabadi, davoud badebarin, Emad Ghabeli, Sina Zarrintan



Background: The management of long-gap esophageal atresia (LGEA) remains challenging and esophageal replacement is necessary in a number of cases, with the conduit of choice for potential surgical expertise. The current study aimed at assessing the outcomes of gastric pull-up surgery for esophageal reconstruction in children with LGEA, and investigating the postoperative results, complications, and mortality.

Materials and Methods: Sixteen patients with LGEA were studied at Tabriz Children’s Hospital, Tabriz, Iran. Gastric pull-up technique was used for esophageal replacement in all the patients. The study duration was 23 months from April 2014 to March 2016.

Results: The mean age of the patients was 7.31 ± 3.91 days. Eleven patients (68.75%) were male and five (31.25%) female. Seven patients (43.75%)  had esophageal atresia type A and nine patients (56.25%) had the type C. All patients (100%) were in need for postoperative mechanical ventilation. Mean period of postoperative mechanical ventilation was5.69 ± 0.87  days. Postoperative mortality was observed in three patients (18.75%). Patients were followed up for six months after the operation; poor feeding was observed in four patients(30.77%) , mild respiratory distress in three patients (23.08%), and choking and aspiration in three patients  (%23.08).

Conclusion: It was observed that gastric pull-up technique was a feasible and safe surgical method for patients with long-gap esophageal atresia when primary anastomosis was not possible. Quality of life, feeding, and growth pattern were also acceptable. However, long-term outcomes were not assessed in the current study.


Esophageal Atresia; Gastric Pull-up; Neoesophagus; Esophagogastrostomy

Full Text:




Shieh HF, Jennings RW. Long-gap esophageal atresia. Semin Pediatr Surg. 2017 Apr;26(2):72-77.

Van der Zee DC, Bagolan P, Faure C, Gottrand F, Jennings R, Laberge JM, Martinez Ferro MH, Parmentier B, Sfeir R, Teague W. Position Paper of INOEA Working Group on Long-Gap Esophageal Atresia: For Better Care. Front Pediatr. 2017 Mar 31;5:63.

Bairdain S, Hamilton TE, Smithers CJ, Manfredi M, Ngo P, Gallagher D, Zurakowski D, Foker JE, Jennings RW. Foker process for the correction of long gap esophageal atresia: Primary treatment versus secondary treatment after prior esophageal surgery. J Pediatr Surg. 2015 Jun;50(6):933-7.

Hackam DJ, Grikscheit T, Wang K, Upperman JS, Ford HR. Pediatric Surgery. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews, JB, Pollock RE (eds). Schwartz’s Principles of Surgery, McGraw-Hill, New York, USA, 2015, pp. 1608-12.

Gallo G, Zwaveling S, Groen H, Van der Zee D, Hulscher J. Long-gap esophageal atresia: a meta-analysis of jejunal interposition, colon interposition, and gastric pull-up. Eur J Pediatr Surg. 2012 Dec;22(6):420-5.

Bagolan P, Iacobelli Bd Bd, De Angelis P, di Abriola GF, Laviani R, Trucchi A, Orzalesi M, Dall'Oglio L. Long gap esophageal atresia and esophageal replacement: moving toward a separation? J Pediatr Surg. 2004 Jul;39(7):1084-90.

Loukogeorgakis SP, Pierro A. Replacement surgery for esophageal atresia. Eur J Pediatr Surg. 2013 Jun;23(3):182-90.

Hunter CJ, Petrosyan M, Connelly ME, Ford HR, Nguyen NX. Repair of long-gap esophageal atresia: gastric conduits may improve outcome-a 20-year single center experience. Pediatr Surg Int. 2009 Dec;25(12):1087-91.

Rescorla FJ, West KW, Scherer LR 3rd, Grosfeld JL. The complex nature of type A (long-gap) esophageal atresia. Surgery. 1994 Oct;116(4):658-64.

Ruiz de Temiño M, Esteban JA, Elías J, González N, Gracia J, Romeo M, Escartín R, Burgués P, Sainz A, Pueyo C. Esophageal atresia type I. Is impossible possible? Cir Pediatr. 2006 Jan;19(1):39-45.

Hirschl RB, Yardeni D, Oldham K, Sherman N, Siplovich L, Gross E, Udassin R, Cohen Z, Nagar H, Geiger JD, Coran AG. Gastric transposition for esophageal replacement in children: experience with 41 consecutive cases with special emphasis on esophageal atresia. Ann Surg. 2002 Oct;236(4):531-9; discussion 539-41.

Anderson KD, Noblett H, Belsey R, Randolph JG. Long-term follow-up of children with colon and gastric tube interposition for esophageal atresia. Surgery. 1992 Feb;111(2):131-6.

Gallo G, Zwaveling S, Van der Zee DC, Bax KN, de Langen ZJ, Hulscher JB. A two-center comparative study of gastric pull-up and jejunal interposition for long gap esophageal atresia. J Pediatr Surg. 2015 Apr;50(4):535-9.

Al-Shanafey S, Harvey J. Long gap esophageal atresia: an Australian experience. J Pediatr Surg. 2008 Apr;43(4):597-601.

Lessin MS, Wesselhoeft CW, Luks FI, DeLuca FG. Primary repair of long-gap esophageal atresia by mobilization of the distal esophagus. Eur J Pediatr Surg. 1999 Dec;9(6):369-72.

Lochbühler H. Long segment esophageal atresia and possibilities of esophageal replacement. Monatsschr Kinderheilkd. 1990 Feb;138(2):50-5.

Bagolan P, Valfrè L, Morini F, Conforti A. Long-gap esophageal atresia: traction-growth and anastomosis - before and beyond. Dis Esophagus. 2013 May-Jun;26(4):372-9.

Hecker WC. Long-gap esophageal atresia: experience with Kato's instrumental anastomosis, with cervicothoracic procedure and primary anastomosis, and with retrosternal colonic interposition. Prog Pediatr Surg. 1986;19:9-21.

Ahmed A, Spitz L. The outcome of colonic replacement of the esophagus in children. Prog Pediatr Surg. 1986;19:37-54.

Burgos L, Barrena S, Andrés AM, Martínez L, Hernández F, Olivares P, Lassaletta L, Tovar JA. Colonic interposition for esophageal replacement in children remains a good choice: 33-year median follow-up of 65 patients. J Pediatr Surg. 2010 Feb;45(2):341-5.

Pedersen JC, Klein RL, Andrews DA. Gastric tube as the primary procedure for pure esophageal atresia. J Pediatr Surg. 1996 Sep;31(9):1233-5.

Ein SH. Gastric tubes in children with caustic esophageal injury: a 32-year review. J Pediatr Surg. 1998 Sep;33(9):1363-5.

Lee HQ, Hawley A, Doak J, Nightingale MG, Hutson JM. Long-gap oesophageal atresia: comparison of delayed primary anastomosis and oesophageal replacement with gastric tube. J Pediatr Surg. 2014 Dec;49(12):1762-6.

Liu J, Yang Y, Zheng C, Dong R, Zheng S. Surgical outcomes of different approaches to esophageal replacement in long-gap esophageal atresia: A systematic review. Medicine (Baltimore). 2017 May;96(21):e6942.



  • There are currently no refbacks.