Pediatric Laparoscopic-Assisted Gastric Transposition: Early Experience and Outcomes

Abstract

astric transposition in children is a well-established treatment for long-gap esophageal atresia and long caustic strictures when preservation of the native esophagus is impossible, but does involve laparotomy and, often, thoracotomy incisions. The minimally invasive approach to this operation has been attempted in 7 patients to date in the UK, all at Great Ormond Street Hospital (London, UK). Four patients were male, 3 were female, with a mean age of 3 years and 7 months (range, 5 months to 13 years). Indications were long-gap esophageal atresia where primary anastomosis was impossible (5 patients) and caustic ingestion with long esophageal strictures (2 patients). The stomach was mobilized laparoscopically by using 5-mm instruments and a pneumoperitoneum of 10 mm Hg. Following pyloromyotomy or pyloroplasty, a tunnel in the posterior mediastinum was developed. The fundus of the stomach was drawn to the neck and sutured to the cervical esophagus. The patients were ventilated on our intensive care unit and then returned to the surgical ward before discharge. Gastric transposition was completed laparoscopically in 6 of 7 patients. The mean duration of surgery was 327 minutes (range, 240-455). All patients survived. Minor complications were pneumonia (2), pleural effusion (1), and hiatus hernia (2). The mean hospital stay was 16 days (range, 8-36). Our preliminary experience would suggest that laparoscopic gastric transposition is a safe alternative to open surgery with satisfactory results.

Laparoscopic-assisted transhiatal gastric transposition for long gap esophageal atresia in an infant

“…As shown by other authors, laparoscopic-assisted gastric transposition is a safe and effective technique with outcomes comparable to the open approach [1][2][3][4][5][6]. With more than 20 months of follow-up, our patient is taking all nutrition by mouth and thriving.…”

“…After a sentinel report by Ure [1] in 2003, a handful of cases have been reported using a laparoscopic technique [2][3][4][5]. The most compelling argument for the laparoscopic approach is improved safety with the ability to perform the posterior mediastinal dissection under direct visualization.…”

“…Although controversy exists as to the best conduit for esophageal replacement, our group has favored gastric transposition with an esophagogastric anastomosis. As minimally invasive techniques have advanced, a few authors have reported success with laparoscopic-assisted gastric transposition [1][2][3][4][5]. In this report, we describe a successful technique for laparoscopicassisted transhiatal gastric transposition for LGEA in an 8-week-old, former 36-week infant (3.77 kg) with more than 20 months of follow-up.…”

Hiatus Hernia after Laparoscopically Assisted Gastric Pull-Up for Esophageal Replacement

“…A modifi cation of the laparoscopic technique might be necessary. Stanwell et al [6] advocated repairing the hiatus prophylactically to avoid the development of hiatus hernia in later life. Our case shows that the extent of hiatus reconstruction remains to be established.…”

“…Hiatus hernia is a very rare complication after conventional gastric pull-up [7,8] . In a recent publication, Stanwell et al [6] analyzed 7 children who had undergone laparoscopically assisted gastric transposition. 2 of these patients developed hiatus hernia and required laparoscopic repair.…”