| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 27
| Issue : 2 | Page : 173-179 |
Reverse gastric tube esophagoplasty with and without lower esophageal stump wrap – Comparison of outcome
Prema Menon1, Katragadda Lakshmi Narasimha Rao1, Ram Samujh1, Sandhya Yaddanapudi2
1 Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Correspondence Address:
Dr. Prema Menon
Room No. 3103, Level 3-A, Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jiaps.JIAPS_356_20
Aim and Objectives: The aim of the study is to compare the outcome in children born with long-gap esophageal atresia following reverse gastric tube esophagoplasty (RGTE) with or without the lower esophageal stump as a “fundoplication” wrap.
Materials and Methods: All children who underwent RGTE between 2008 and 2018 were retrospectively analyzed. Patients in whom the lower esophagus (LE) had been excised as is done routinely in RGTE (Group 1) were compared with those where the LE was wrapped partially or completely around the intraabdominal neo-esophagus (Group 2). Both vagal nerves were preserved to the extent possible. Complications and final outcome, including weight and height centiles were assessed. Follow-up upper gastrointestinal contrast study and reflux scans were studied.
Results: Nineteen patients (mean age: 15.78 ± 5.02 months [range 10–30 months] at RGTE) were studied; nine in Group 1 and ten in Group 2. Both groups had similar early postoperative complications as well as the requirement of dilatation for anastomotic stricture. Dysphagia for solids was noticed in two patients with complete lower esophageal wrap (n = 4), one requiring removal. More patients in Group 2 had absent reflux (n = 7) compared to Group 1 (n = 3) (P = 0.118). At a mean follow-up period of 45.75 ± 18.77 months (14–84 months), Group 2 children reached better height and weight percentiles compared to Group 1.
Conclusion: We have described a novel method of using the LE as a “fundoplication” wrap following RGTE. Vagi should be preserved. Those with complete esophageal wrap may develop dysphagia to solids and this is, therefore, not recommended. Lower esophageal wrap patients appeared to have a better outcome in terms of growth and less reflux.
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