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COMMENTARY |
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| Year : 2016 | Volume
: 21
| Issue : 3 | Page : 115 |
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Reviewer's commentary
Satish Kumar Aggarwal
Senior Consultant Paediatric Surgeon, Sir Ganga Ram Hospital, New Delhi, India
| Date of Web Publication | 18-May-2016 |
Correspondence Address:
Satish Kumar Aggarwal
Former Director Professor and Head, Department of Paediatric Surgery, MAMC, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 27365903 
How to cite this article:
Aggarwal SK. Reviewer's commentary. J Indian Assoc Pediatr Surg 2016;21:115 |
It is an important contribution highlighting specific problems and immediate post-operative complications of Gastric Pull up (GPU) versus Gastric Tube (GT).
The authors have stressed on an important aspect in their series: the immediate complications are more with GPU while late problems occur more frequently with GT. The potentially fatal complication of tachyarrythmias is indeed a serious issue. Need for ventilatory support and tachyarrythmia are both related to the effect of a bulky stomach in the tight mediastinum. Tachyarrythmias also occur because of loss of vagal inhibition during surgery (few cardiac vagal fibers are almost always severed during mediastinal dissection). Through my personal journey with over 50 GPUs at Maulana Azad Medical College, New Delhi, I have adopted some techniques to tackle these issues. They are: peri-operative use of beta blockers (Metoprolol, 7 days before and 5 days after surgery) to prime the heart against vagal disinhibition; and use of lesser curve gastroplasty during oesophageal stump closure (to debulk the stomach). Lesser curve gastroplasty leads to minimum loss of stomach capacity but facilitates easy passage of the stomach through the narrowest part of the mediastinum at the thoracic inlet.
I routinely suggest bronchoscopy pre-operatively to exclude tracheomalacia, which can worsen post-operatively. The authors have had commendable experience with GPU and I compliment them on their results.
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