Laparoscopic Transhiatal Esophagectomy and Gastric Pull-Up in Long-Gap Esophageal Atresia: Description of the Technique in Our First 10 Cases

Abstract The definition accepted for the largely controversial and multiple criteria condition known as long-gap esophageal atresia (LGEA) is “inability to achieve primary end-to-end anastomosis,” particularly in the presence of a tracheo-esophageal fistula. In this article we report our technique of laparoscopic transhiatal esophagectomy and gastric pull-up (TEGPUL) in LGEA, based on the open approach of Spitz. Differences between TEGPUL and the original technique are the absence of a pyloromyotomy, the peel-away technique, the gastric pull-up through the distal esophagus, and its extracorporeal section. We performed the technique in 10 patients: 6 girls and 4 boys. Six had esophageal atresia type III (60%), three had esophageal atresia type I (30%) and one had esophageal atresia type II (10%). Mean time in surgery was 4.43 hours (range, 3.3–7 hours). Average stay in the pediatric intensive care unit was 5.9 days (range, 3–25 days). Average time under mechanical ventilation was 4.6 days (range, 2–8 days)...