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



Introduction: The management of long-gap esophageal atresia (LGEA) remains challenging and esophageal replacement is inevitable in some patients. The current study aimed at assessing the outcomes of gastric pull-up surgery for esophageal reconstruction in neonates with LGEA, and investigating the postoperative results, complications, and mortality.
Materials and Methods: In a prospective study 16 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 neonates was 7.31 ± 3.91 days. Eleven patients (68.75%) were male and five (31.25%) female. Seven neonates (44%) had esophageal atresia type A and nine patients (56%) had type C. All of them (100%) were in need for postoperative mechanical ventilation. Mean period of postoperative mechanical ventilation was 0.87±5.69 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 is a feasible and safe surgical method for neonates with long-gap esophageal atresia when primary anastomosis is 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

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

van der Zee DC, Bagolan P, Faure C, et al: Position Paper of INoEA Working Group on Long-Gap Esophageal Atresia: For Better Care. Front Pediatr 2017;5:63.

Bairdain S, Hamilton TE, Smithers CJ, et al: Foker process for the correction of long gap esophageal atresia: Primary treatment versus secondary treatment after prior esophageal surgery. J Pediatr Surg 2015;50(6):933-7.

Hackam DJ, Grikscheit T, Wang K, et al: 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.

Khaleghnejad Tabari A, Rouzrokh M ,Khaleghnajad-Tabari N: Gastric tube interposition for esophageal replacement in children, is it the best option? Iranian Pediatr Surg 2015; 22(6):58-62.

Bagolan P, Iacobelli Bd Bd, De Angelis P, et al: Long gap esophageal atresia and esophageal replacement: moving toward a separation? J Pediatr Surg 2004;39(7):1084-90.

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

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

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

Ruiz de Temiño M, Esteban JA, Elías J, et al: Esophageal atresia type I. Is impossible possible? Cir Pediatr 2006;19(1):39-45.

Hirschl RB, Yardeni D, Oldham K, et al: Gastric transposition for esophageal replacement in children: experience with 41 consecutive cases with special emphasis on esophageal atresia. Ann Surg 2002;236(4):531-9.

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

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

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

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

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

Bagolan P, Valfrè L, Morini F, et al: Long-gap esophageal atresia: traction-growth and anastomosis - before and beyond. Dis Esophagus 2013;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, et al: Colonic interposition for esophageal replacement in children remains a good choice: 33-year median follow-up of 65 patients. J Pediatr Surg


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

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

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

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



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