Background; Esophageal atresia (EA) presents a challenging scenario in pediatric surgery. Gastric pull-up (GPU) has emerged as a viable surgical option for esophageal reconstruction in these patients, offering several advantages.
Aim & Objectives: The aim of this study was to report the results of pediatric esophageal substitution by gastric pull-up in pure esophageal atresia (EA) and EA with distal tracheo-esophageal fistula (TEF) from a tertiary care pediatric surgery center.
Materials and Methods: This is a Retrospective and prospective analysis done in department pediatrics surgery SMS Medical college Jaipur from January 2021 to July 2023, of the surgical techniques, results, complications, and outcomes of 15 pediatric patients who underwent esophageal substitution in a single tertiary care referral institution over a 2-year period. All cases were operated by a single surgeon with >8 years experience of performing gastric pull-ups.
Results: Fifteen substitutions (gastric pull up) were performed over a 2- year period. The indications were pure EA and EA with TEF. Mean age and weight at operation were 18 months and 9.5 kilograms (kgs) respectively. Posterior mediastinal and retrosternal routes were used in these cases. Major complications included postoperative cervical anastomotic leak. Perioperative and postoperative tachyarrhythmias were not reported. The postoperative intensive care stay was uneventful. Follow-up has been uneventful with no major growth-related problems.
Conclusions: The gastric transposition is feasible, simple, and safe. GPU represents a valuable surgical technique for esophageal reconstruction in patients with esophageal atresia. It allows for the creation of a functional esophagus, enabling oral feeding and promoting normal growth and development. This holistic approach helps ensure that patients not only recover from surgery but also thrive in the long term, achieving normal growth and development.
Keywords: Gastric pull-up, Esophageal atresia, Tracheo-esophageal fistula, Pediatric Esophageal Substitution, Surgical outcomes
