A 1-day-old infant with esophageal atresia undergoes successful esophageal substitution surgery.

About The Patient and Condition

A 1-day-old infant boy was referred from Nepal with wide gap pure esophageal atresia.

Case Scenario

The infant was admitted under the care of Dr. Deepak Kumar Kandpal, Pediatric Surgeon at Apollomedics Super Specialty Hospital, Lucknow. The infant had excessive and frothy salivation through mouth and nose. The nasogastric tube was not negotiable beyond 8 cm from the gum margin. On X-ray chest and abdomen, the nasogastric tube was seen to be coiled in the neck and the abdomen was totally gasless. The infant had absent food pipe and in such cases primary anastomosis is not possible due to a very wide gap between the esophageal ends. Other associated congenital anomalies were ruled out by USG cranium, abdomen and 2D Echocardiography.

The infant underwent a feeding gastrostomy for feeding directly into the stomach and a cervical esophagostomy to drain the oral secretions. Esophagostomy was done as there was risk of infant aspirating in his own saliva and pneumonia due to secretions going into the lungs. The infant was discharged from the hospital after parents were taught how to feed through the gastrostomy tube and care of esophagostomy and gastrostomy.

The infant was under regular follow up for 8 months. The esophageal substitution surgery was planned using stomach as the conduit by gastric transposition.

Abdomen was opened by midline incision and gastrostomy was taken down. The greater omentum was divided, taking great care to maintain the gastroepiploic arcade. The left gastric artery was divided and ligated. The right gastric artery was identified and preserved. An extensive Kocher maneuver was performed to mobilize the duodenum. The esophageal hiatus was then opened to allow easy passage of the stomach.

A left cervical incision was made around the esophagostomy and esophagus was mobilized for a distance of 2-3 cm. The mediastinum was bluntly dissected and a tunnel was created between the cervical incision and the esophageal hiatus. The stomach was then brought up through the posterior mediastinal route to the cervical incision and a single layer anastomosis done between fundus and the cervical esophagus.

A back up feeding jejunostomy was also performed. The infant was managed in PICU on mechanical ventilation for four days. Thereafter, he was weaned off ventilator support and placed on oxygen by high flow nasal cannula for two more days. A contrast swallow study was done on 8th postoperative day, which showed wide open esophagogastric anastomosis, no anastomotic leak and prompt gastric emptying. Oral feeds were initiated and gradually increased in volume. The infant initially had some oral aversion to food but the oral acceptance to food improved in couple of days.

The infant was discharged from the hospital on full oral feeds with a total hospital stay of 2 weeks and a remarkably uneventful course after an extensive reconstructive surgery.

Worldwide Scenario

Esophageal substitution in children is indicated in few clinical situations including complex esophageal atresia and unresponsive corrosive strictures. Esophageal substitution in children across the world at advanced centres remains a major surgery with high complication rates.

Expertise at Apollo Hospitals

With most busy centres reporting one to two cases annually, it is one the most challenging surgery in children. We at Apollomedics Super Specialty Hospital, Lucknow have successfully performed two case in last one year.

Apollo Hospitals – Touching Lives

Two successful pediatric esophageal substitution surgeries in one year is a testimonial to the state of art facilities, pediatric surgical and intensive care expertise available at the Apollomedics Super Specialty Hospital, Lucknow.

Patient’s Testimonial

Annaprashanam, is a Hindu rite of passage (Samskara) that marks an infant’s first intake of food other than milk and is considered an important milestone. After surgery the child was able to take food orally first time since his birth, this was celebrated as Annaprashanam ceremony by the pediatric ICU nurses. This was an emotional moment for the parents and they were extremely grateful to the entire team at Apollomedics Super Specialty Hospital, Lucknow.