One year old female baby presented as a case of pure esophageal atresia and had underwent feeding gastrostomy and cervical esophagostomy in the neonatal period. The baby was admitted for definitive repair. The baby underwent Gastric pull up surgery. Gastric pull-up, also known as gastric transposition, is a surgical procedure that replaces a section of the child’s damaged or otherwise underdeveloped esophagus with stomach which is pulled up or lifted from the tissues in the abdomen and brought up and reconnected to the remaining upper esophagus to restore the ability to swallow and for food to travel down via the stomach and into the intestines. This allows the child to eat normally. This is also known as esophageal replacement surgery as other organs can also be replaced, in case stomach is not available, like small intestine and colon.
A variety of conditions may require a gastric pull-up operation, particularly in infants and children. As no replacement works as well as the child’s own esophagus, every effort will be made to repair or salvage the esophagusthe child may require a gastric pull-up due to the following conditions:
This surgery may require abdominal, throat or chest incisions depending on the severity of damage. Typically the child will receive intravenous (IV) nutrition for the first two days after the operation and then he is started on jejunostomy feeds – which is a through a tube which is placed in the intestine at the time of the operation. At the 7th postoperative day a dye study is done in x-ray to check for the healing of the anastomosis and then the child is allowed to have liquids by mouth. Gradually semisolids are introduced orally and feeding is done in head up position so as to prevent reflux of the acidic contents.
As withany surgical procedure, there are possible short and long-term complications. Potential risks include:
Some complications may require additional treatment and / or surgery – endoscopic dilation for the narrowing at the junction or revision of the anastomosis if the endoscopic dilation does not work.
Initial recovery from gastric pull-up lasts approximately one month, including a hospital stay of 10 to 12 days. The child’s condition in the following weeks and months and the feeding jejunostomy tube is removed after one month or later if he undergoes dilation . Depending on the child’s progress, he may require occasional follow-up visits in coming years.