A two-center comparative study of gastric pull-up and jejunal interposition for long gap esophageal atresia

Oesophageal replacement with stomach: A personal series and review of published experience

“…Of eight survivors, six have evidence of reflux damage to their remaining oesophagus. Our chronic morbidity mirrors a recent Dutch report of nine children followed up following gastric transposition, where 44% showed reflux symptoms at a median of 14 years following surgery . Of more concern is our finding of Barrett's epithelium in one child, now 10 years following surgery, and with a further life expectancy of perhaps 70 years.…”

“…Two children developed an anastomotic leak manifested by a salivary discharge from their cervical wound, for a leak rate of 20%. There was no systemic upset in either case; both closed spontaneously, but many reports describe operative intervention to achieve closure . The cumulated incidence of leak is 93/578 (16%).…”

“…One of our procedures followed a failed attempt at a Foker oesophageal mobilisation . It is noticeable how often, in the reports of gastric transposition, the preceding procedure has been a failed Foker type of mobilisation . We note that even when the use of this technique leads to catastrophic outcomes, surgeons continue to endorse the procedure…”

“…Atwell's landmark 1980 publication reported remarkably little morbidity but had no endoscopic assessment of the remaining oesophagus . Gallo described seven of nine (77%) children with gastrointestinal symptoms, six of nine were on proton pump inhibitors, three of nine were dependent on jejunal feeding and four of nine were more than 2 standard deviations below average for weight . Reismann documented all nine of their patients receiving proton pump inhibitors, seven of nine with a stenosis, four of nine had experienced a pneumonia and four of nine had pathological gastro‐oesophageal reflux .…”

“…Reduction in stomach size lead to permanent resolution. In the published experience, pneumothorax is the most common early respiratory complication . One series reported either a pleural effusion or pneumonia in 25% of cases .…”