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Neonatal Med > Volume 25(4); 2018 > Article
Neonatal Medicine 2018;25(4):186-190.
DOI: https://doi.org/10.5385/nm.2018.25.4.186    Published online November 30, 2018.
Esophageal Reconstruction with Gastric Pull-up in a Premature Infant with Type B Esophageal Atresia
Young Mi Han1, Narae Lee1, Shin Yun Byun1, Soo-Hong Kim2, Yong-Hoon Cho2, Hae-Young Kim2
1Division of Neonatology, Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of Medicine, Yangsan, Korea
2Division of Pediatric Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
Corresponding author:  Yong-Hoon Cho, Tel: +82-55-360-2124, Fax: +82-55-360-2154, 
Email: choyh70@pusan.ac.kr
Received: 14 July 2018   • Revised: 22 August 2018   • Accepted: 8 September 2018
Abstract
Esophageal atresia (EA) with proximal tracheoesophageal fistula (TEF; gross type B) is a rare defect. Although most patients have long-gap EA, there are still no established surgical guidelines. A premature male infant with symmetric intrauterine growth retardation (birth weight, 1,616 g) was born at 35 weeks and 5 days of gestation. The initial diagnosis was pure EA (gross type A) based on failure to pass an orogastric tube and the absence of stomach gas. A “feed and grow” approach was implemented, with gastrostomy performed on postnatal day 2. A fistula was detected during bronchoscopy for recurrent pneumonia; thus, we confirmed type B EA and performed TEF excision and cervical end esophagostomy. As the infant’s stomach volume was insufficient for bolus feeding after reaching a body weight of 2.5 kg, continuous tube feeding was provided through a gastrojejunal tube. On the basis of these findings, esophageal reconstruction with gastric pull-up was performed on postnatal day 141 (infant weight, 4.7 kg), and he was discharged 21 days postoperatively. At 12 months after birth, there was no catch-up growth; however, he is currently receiving a baby food diet without any complications. In patients with EA, bronchoscopy is useful for confirming TEF, whereas for those with long-gap EA with a small stomach volume, esophageal reconstruction with gastric pull-up after continuous feeding through a gastrojejunal tube is worth considering.
Key Words: Esophageal atresia, Tracheoesophageal fistula, Premature infant


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