In a setting of esophageal replacement, total gastric pull-up has fewer complications than partial gastric pull-up

Published:November 18, 2022DOI:



      The main indications for an esophageal replacement (ER) are unresolved complex esophageal atresia (EA) and caustic strictures (CS). The use of different organs for replacement has been described. When the stomach is chosen, there are two ways to do a gastric pull-up: a partial (PGP) or a total pull-up (TGP). Few studies have been published comparing the different techniques. The aim of this study was to compare the outcomes of patients who underwent ER by PGP or by TGT.


      The medical records of all patients who underwent gastric pull-up for ER in the last 18 years at the National Pediatric Hospital Prof. Dr. Juan P. Garrahan were reviewed. The study is comparative, retro-prospective and longitudinal. Patients were divided in two groups according to the ER technique (PGP or TGP). We compared the following outcomes: duration of the operation, days of hospitalization in the intensive care unit (ICU), days of total hospitalization, time to initiation of oral feedings and rate of anastomosis dehiscence, incidence of anastomotic stenosis, need for re-operations, incidence of gastroesophageal reflux disease (GERD), incidence of tracheo-esophageal fistulas (TEF), incidence of dumping syndrome, incidence of gastric necrosis and mortality.


      There were 92 patients included in the study: 70 in the PGP group (76%) and 26 in the TGP group (24%). The two groups were demographically equivalent. Patients in the TGP group had a statistically significant lower incidence of anastomotic dehiscence (22,7% versus 54,3%; p=0.01) and dumping syndrome (13,6% versus 37,1%; p=0.038). Patients in the TGP had lower incidence of anastomotic stenosis, although the difference was not statistically significant. There were no statistically significant differences between the groups in terms of duration of the operation, postoperative days in the ICU, time to oral feedings, GERD, TEF or overall hospital stay. There were no cases of gastric necrosis. There were 3 deaths in the PGP group and one in the TGP group.


      We observed benefits in the TGP group versus the PGP approach in terms of anastomotic dehiscence and dumping syndrome, as well as a trend toward a lower incidence of anastomotic stenosis. Based on this experience, we recommend the TGP approach for patients who need an esophageal replacement by a gastric pull-up.

      Levels of evidence

      According to the Journal of Pediatric Surgery this research corresponds to type of study level III for retrospective comparative study.


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        • Friedmacher F.
        • Puri P.
        Delay primary anastomosis for management of long gap esophageal atresia: a meta-analysis of complications and long-term outcome.
        Pediatr Surg Int. 2012; 28: 899-906
        • Ahmad S.
        • Sylvester K.
        • Hebra A.
        • et al.
        Esophageal replacement using the colon: is a good choice?.
        J Pediatr Surg. 1996; 31: 1026-1031
        • Saeki M.
        • Tsuchida Y.
        • Ogata T.
        • et al.
        Long-term results of jejunal replacement of the esophagus.
        J Pediatr Surg. 1988; 23: 483-489
        • Spitz L.
        • Kialy E.
        • Pierro A.
        Gastric transposition in children – a 21 year experience.
        J Pediatr Surg. 2004; 39: 276-291
        • Borgnon J.
        • Tounian P.
        • Auber F.
        • et al.
        Esophageal replacement in children by an isoperistaltic gastric tube: a 12-year experience.
        Pediatr Surg Int. 2004; 20: 829-833
        • Schärli A.
        Esophageal reconstruction in very long atresias by elongation of the lesser curvature.
        Pediatr Surg Int. 1992; 7: 101-105
        • Tannuri U.
        • Maksud-Filho J.
        • Tannuri C.
        • et al.
        Which is better esophageal substitution in children, esophagoplasty or gastric transposition? A 27-year experience of a single center.
        J Pediatr Surg. 2004; 39: 545-548
        • Lindahl H.
        • Louhimo I.
        • Virkola K.
        Colon interposition or gastric tube? Follow-up study of colon-esophagus and gastric tube-esophagus patients.
        J Pediatr Surg. 1983; 18: 829-839
        • Anderson K.
        • Noblett H.
        • Belsey R.
        • et al.
        Long-term follow-up of children with colon and gastric tube interposition for esophageal atresia.
        Surgery. 1992; 111: 131-136
        • Gallo G.
        • Zwaveling S.
        • Groen H.
        • et al.
        Long-gap esophageal atresia. A meta-analysis of jejunal interposition, colon interposition, and gastric pull-up.
        Eur J Pediatr Surg. 2012; 22: 420-425
        • Tannuri U.
        • Tannuri A.
        • Goncalves M.
        • et al.
        Total gastric transposition is better than partial gastric tube esophagoplasty for esophageal replacement in children.
        Dis Esophagus. 2008; 21: 73-77
        • Choudhury S.
        • Yadav P.
        • Khan N.
        • et al.
        Pediatric esophageal substitution by gastric pull-up and gastric tube.
        J Indian Assoc Pediatr Surg. 2016; 21: 110-114
        • Collard J.
        • Tinton N.
        • Malaise J.
        • et al.
        Esophageal replacement: gastric tube or whole stomach?.
        Ann Thorac Surg. 1995; 60: 261-267
        • Rubio M.
        • Boglione M.
        • Fraire C.
        • et al.
        Seventy cases of partial gastric pull-up according to the Schärli technique for esophageal replacement in pediatrics.
        Pediatr Neonatal Nurs Open J. 2020; 7: 1-7
        • Spitz L.
        Gastric transposition via the mediastinal route for infants with long-gap esophageal atresia.
        J Pediatr Surg. 1984; 19: 149-154
        • Bealsey S.
        • Skinner A.
        Modified Scharli technique for the very long gap esophageal atresia.
        J Pediatr Surg. 2013; 48: 2351-2353
        • Sweet R.
        A new method of restoring continuity of the alimentary canal in cases of congenital atresia of the esophagus with tracheo-esophageal fistula not treated by inmediate primary anastomosis.
        Ann Surg. 1946; 127: 757-768
        • Samuk I.
        • Afriat R.
        • Horne T.
        • et al.
        Dumping syndrome following Nissen fundoplication, diagnosis, and treatment.
        J Pediatr Gastroenterol Nutr. 1996; 23: 235-240
        • van Beek A.
        • Emous M.
        • Laville M.
        • et al.
        Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management.
        Obes Rev. 2017; 18: 68-85
        • Kudo T.
        • Abo S.
        • Itabashi T.
        Prognosis of esophageal substitute in tissue viability and anastomotic leakage.
        Dis Esophagus. 1998; : 522-525