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Laparoscopic Assisted Gastric Pull-up for Long-gap Esophageal Atresia - Technical Aspects
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Contributors: Kamal Dev LAPAROSCOPIC ASSISTED GASTRIC PULL-UP FOR LONG-GAP ESOPHAGEAL ATRESIA - TECHNICAL ASPECTS Hans Joachim Kirschner, MD, Joerg Fuchs, MD. University Children’s Hospital Tuebingen, Tuebingen, Germany. Purpose: We present the case of a four-month-old boy undergoing laparoscopic assisted gastric pull-up for long-gap esophageal atresia without fistula. The patient was an extremely low weight birth infant with a birth weight of 670 gr (gestational age 24 6/7 weeks). Sump suction drainage of the upper pouch and gastrostomy were performed initially. The esophageus showed no sufficient length after 4 months. Therefore, decision was taken to perform a laparoscopic assisted gastric pull-up. Methods: A three port technique was used for the minimal invasive approach. After abdominal dissection of the stomach, the midline tunnel was created laparoscopically through the hiatus window. The stomach was transferred through the extended subumbilical port incision and was prepared for the pull-up extracorporeally. A dilatation balloon catheter was inserted through the site of the gastrostomy for controlled dilatation of the pyloric muscle to avoid pyloroplasty. The upper esophageal pouch was dissected and the gastric pull-up and the anastomosis were performed through a cervical incision. Results: The postoperative course was uneventful. X-Ray contrast study and repeated esophagogastroscopy showed an adequate opening of the pylorus and absence of anastomosis stricture postoperatively. Oral feeding was uneventful after successful physiotherapy for swallowing Conclusion: Laparoscopic assisted gastric pull-up can be carried out safely in small infants. This video highlights the essential steps of the procedure. DOI: https://doi.org/10.17797/hjl4mzq5lt

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