Minimally invasive esophagectomy and gastric pull-up in children

Purpose: Minimally invasive esophagectomy and gastric pull-up is a widely accepted method in adults. However, the experience in the pediatric population is limited. Minimally invasive esophagectomy represents a new alternative technique to the conventional open approach. We wish to report our small case series of minimally invasive esophagectomy and gastric pull-up in pediatric patients. The aim of the study is to evaluate the feasibility, safety, and outcomes of the procedure. Methods: Three patients (2 girls and 1 boy) with average age 46 months (34-57 months) and average weight 12.6 kg (11-15 kg) underwent the procedure. The indications for esophagectomy were esophageal stricture from caustic ingestion (2 patients) and failed repair of esophageal atresia (1 patient). Results: Average operative time was 7 h (0519-0752 hours). There were no intraoperative complications with the average blood loss of 50 cc (5-125 cc). No anastomotic leaks were noted on the initial esophagrams that were obtained on postoperative day five or six. One patient developed a cervical wound infection on postoperative day seven due to a retained piece of Penrose, which required a neck exploration, removal of foreign body and repair of a small leak. One patient developed an anastomotic stricture at the 7-month follow-up. She was successfully treated with two balloon dilatations. One patient developed a delayed esophagogastric anastomotic leak at 3 months. The leak spontaneously closed after surgical drainage. At average of 22-month follow-up (15-36 months), all patients were eating regular food with excellent weight gain. Conclusion: Minimally invasive esophagectomy and gastric pull-up is technically challenging but feasible and safe with acceptable outcomes. However, further study is needed to further validate the approach.