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Congenital intrathoracic stomach can be safely managed laparoscopically

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Abstract

Purpose

Congenital intrathoracic stomach (CIS) is an uncommon pediatric surgical diagnosis where > 2/3rd of the stomach lies within the chest through a hiatus defect. We reviewed our recent experience with this condition.

Methods

A retrospective single-center review of children with a diagnosis of CIS (2007–2018) was performed. Patient demographics, presentation, imaging and management were assessed. Results are expressed as median (range).

Results

Eleven patients (6 girls) were identified with onset of symptoms at 2 (0–26) months of age. Presenting symptoms were vomiting (8/11), respiratory symptoms (4/11) and failure to thrive (2/11). Two patients had Marfan’s syndrome. An upper gastrointestinal contrast study demonstrated gastric herniation in all. All were corrected laparoscopically with hiatus repair and fundoplication [age at surgery 10.5 (1.5–34.5) months]. A concurrent gastrostomy was done in children ≤ 6 months (n = 5). Enteral feeds were commenced on post-operative day one in 9 and second post-operative day in 2. At 7 (0–95) months follow-up, all were on full enteral feeds. One patient had a recurrence 6 months post-operatively, which was re-operated laparoscopically without any further recurrence.

Conclusion

This is the largest reported series of children with CIS. All could be managed laparoscopically with no conversions and a low recurrence.

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Acknowledgements

Dr Kieran McHugh (Consultant, Department of radiology, Great Ormond Street Hospital, London, UK) for image review. Prof. Paolo De Coppi is supported by National Institute for Health Research (NIHR-RP-2014-04-046). All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the author (s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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Authors and Affiliations

  1. Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK

    Alisha Gupta, Bushra Zia, Dhanya Mullassery, Paolo De Coppi, Stefano Giuliani, Joseph I. Curry & Kate M. Cross

  2. Stem Cells and Regenerative Medicine Section, Institute of Child Health, University College London, London, WC1N 1EH, UK

    Paolo De Coppi

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  1. Alisha Gupta
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  2. Bushra Zia
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  3. Dhanya Mullassery
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  4. Paolo De Coppi
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Correspondence to Kate M. Cross.

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Gupta, A., Zia, B., Mullassery, D. et al. Congenital intrathoracic stomach can be safely managed laparoscopically. Pediatr Surg Int 36, 165–169 (2020). https://doi.org/10.1007/s00383-019-04588-w

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  • DOI: https://doi.org/10.1007/s00383-019-04588-w

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