Contributors: Kamal Dev
LAPAROSCOPIC ASSISTED GASTRIC PULL-UP FOR LONG-GAP ESOPHAGEAL ATRESIA – TECHNICAL ASPECTS
Hans Joachim Kirschner, MD, Joerg Fuchs, MD.
University Childrenâ€™s Hospital Tuebingen, Tuebingen, Germany.
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.
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.
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
Laparoscopic assisted gastric pull-up can be carried out safely in small infants. This
video highlights the essential steps of the procedure.