Gastric pull-up, also known as gastric transposition, is a surgical procedure that replaces a section of your child’s damaged or otherwise underdeveloped esophagus with reconstructed stomach tissue.

The gastric pull-up is most often used following the surgical removal of a section of the esophagus (esophagectomy).

The pediatric surgeon reconnects the remaining upper esophagus to the stomach to restore the ability to swallow and for food to travel to your child’s stomach. The gastric pull-up procedure and the colonic interposition procedures are two common techniques used to repair the damaged esophagus.

What Is Gastric Pull-Up?

As no replacement works as well as your child’s own esophagus, every effort will be made to repair or salvage the esophagus. When that is not possible the esophagus is repaired using the stomach or colon (large intestine).

During the surgery, your child’s stomach tissue is lifted to meet the remaining tissue of the upper esophagus. This reestablishes full connection between throat and stomach which may allow your child to eat normally.

The gastric pull-up is most often used following the surgical removal of a section of the esophagus (esophagectomy).

Conditions Requiring Gastric Pull-Up

A variety of conditions may require a gastric pull-up operation, particularly in infants and children. If the esophagus cannot be connected together, your child may require a gastric pull-up due to the following conditions:

• Ingestion of a toxic or corrosive substance, called caustic ingestion
• Improper formation of the esophagus at birth, as in Tracheoesophageal Fistula (TEF) and / or Esophageal Atresia (EA)

How Does the Procedure Work?

During the gastric pull-up portion of the procedure, your child’s stomach tissue is pulled up to meet the remaining tissue of the upper esophagus. This reestablishes full connection between throat and stomach.

This surgery may require abdominal, throat or chest incisions depending on the severity of damage. Your doctor will explain the proposed course of action, chosen specifically for your child’s condition.

Preparing for Surgery

Your surgeon and nurses will provide specific instructions based upon details of your child’s operation. These instructions will include information about eating, drinking or g-tube feeds prior to surgery and when to arrive at the hospital if you are not already admitted. Your doctor or nurse will ask about your child’s medications and will let you know if you need to stop these medications for a short time before surgery.

You, your child and other family members may be scared about the surgery. This is completely normal. Please share concerns with doctors and nurses. Also, Child Life representatives have assembled tips and resources to help you prepare for your visit so that you and your child are as comfortable as possible.

If you are traveling to Cincinnati for surgery, our Guest Services representatives are happy to assist in planning your stay. If you are traveling internationally, our International Patient Care team is ready to assist you.

Possible Risks and Complications of Surgery

As with any surgical procedure, there are possible short- and long-term complications. Potential risks include:

• Trouble swallowing
• Weight loss
• Reflux
• Pneumonia
• Narrowing of the esophagus

Some complications may require additional treatment and / or surgery.

Recovery

Your surgeon will provide specific instructions during your child’s recovery period.

Initial recovery from gastric pull-up lasts approximately two months, including a hospital stay of 10 to 21 days.

Typically, your child will receive intravenous (IV) nutrition for the first five to seven days after the operation. Your child may then be allowed to have liquids by mouth or tube feedings may be started. Your child should also use a pillow to raise the head while sleeping. This will prevent stomach acid from moving upward into the esophagus.

The doctor will continue to monitor your child’s condition in the following weeks and months. This monitoring will include office visits and endoscopies in the operating room. Depending on your child’s progress, you may require occasional follow-up visits in coming years.