Introduction
It is also known as gastric transposition. It is most commonly used following surgical removal of the esophagus, a long muscular tube connecting the throat and the stomach. When this is not fully grown, the doctor will use a part of the tissue in the child’s stomach or the intestine. This is done to re-establish the ability to swallow food and to pave the way for easy passage of food to travel from the mouth to the stomach.
When Does a Patient Need a Gastric Pull-Up Surgery?
Many conditions will require gastric pull-up surgery, especially in children and infants. If the esophagus cannot be connected, the child will require gastric pull-up surgery. This procedure is very commonly done after esophagectomy, which removes the usual esophagus procedure for patients suffering from esophageal cancer.
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Caustic Ingestion: The child may swallow something like harmful chemicals, cleaning agents, cosmetics, coins, magnets, small batteries, and watches which can cause major damage like scarring in the tissues in the tube connecting the mouth and the stomach.
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Tracheo Esophageal Fistula (TEF): It is an abnormal opening in places present between the esophagus and the windpipe, which is also called the trachea. Saliva and food particles pass through the esophagus normally, but in the case of a fistula, the abnormal opening will cause the food to pass through it and enter into the lungs, which can cause breathing issues. In premature infants who have an abnormal condition like an underdeveloped lung can cause air to enter into the stomach and esophagus, which can cause swelling, rupture, or issues in respiration.
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Esophageal Atresia: It is another birth defect that is often seen along with TEF, where the esophagus would not have fully formed, and there would be no connection between the mouth and the stomach.
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Hypopharyngeal Carcinoma: Cancer cells form in the region of the hypopharynx, which is the bottom part of the throat.
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Cervical Esophageal Carcinoma: Cancer that grows anywhere in the esophagus, from the throat to the indentation in the middle of the neck between the two collar bones.
What Are the Symptoms of Caustic Ingestion?
A child who has swallowed an object or something stuck in the throat will present with the following symptoms listed below:
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Drooling.
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Spitting up food.
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Pain.
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Refusing food.
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Weight loss.
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Hoarse cry.
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Difficulty in breathing.
What Are the Symptoms of Tracheoesophageal Fistula?
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Coughing or choking during feeding.
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Vomiting.
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Frothy white bubbles in the mouth.
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Difficulty in breathing.
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A full round stomach is usually found in the tracheoesophageal fistula.
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The unusually flat stomach is usually found in esophageal atresia.
How to Diagnose These Conditions?
A complete medical history must be taken, along with a thorough physical examination.
The physical examination is done by inserting the tube through the throat into the stomach. If the tube does not go inside, or there is some trouble inserting the tube into the stomach, then there is a high probability.
How Is This Procedure Performed?
During this procedure, an abdominal, throat, or chest incision is made depending upon the degree of damage caused. The child’s stomach tissue is pulled up and reconnected with the already existing tissue in the upper esophagus. This will re-establish the connection between the throat and the stomach. The doctor will first inspect, analyze and then propose the method depending on the child’s condition.
How Should One Prepare for Surgery?
The doctor will provide the necessary instructions on how to be prepared for the surgery. The instructions will include details like what to eat and drink or when to arrive at the hospital before the day or on the day of surgery. The doctor or the nurse will ask for prescription medicines prescribed to the child and will let the parents or guardian know whether the child should stop taking the medicines or not. This surgery is completely normal, and there is no need to get panicked or tense before surgery.
What Are the Possible Complications of This Surgery?
The possible complications include
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Trouble in swallowing.
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Reflux of the contents from the upper digestive tract.
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Pneumonia (an infection that causes inflammation in the air sacs present in the lungs).
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Esophageal narrowing.
How Will the Recovery Be After This Surgery Is Performed?
After the operation, the surgeon will provide the necessary instructions to the patient. The initial recovery period after the surgery will be approximately sixty days, during which the patient will be staying in the hospital for a minimum of ten days to a maximum of twenty-one days. The child in the hospital will receive nutrition intravenously through trips for the first five to seven days after the surgery. After that, gradually, the child will be allowed to follow a liquid diet by mouth, or if that is uncomfortable, feeding by tube can be initiated. The doctor will advise the child to sleep with a pillow behind the head with the head tilted upwards in a raised position to prevent the acid from the stomach from moving back into the esophagus. The doctor will advise the patient for regular follow-up visits to check the condition. This will usually be done by using an endoscope, a long flexible tube with a lens, and a light source attached. This will help in viewing the interior of the esophagus.
Conclusion
Thus, this procedure is an interesting procedure for comfortable swallowing food and in cases of cancer. Studies have confirmed that this procedure effectively replaces the esophagus with minimal complications. There were also no respiratory issues after the surgery. Proper oral feeding and a good amount of weight gain were successfully made possible in most children following this procedure.
