Surgery to give child first bite

A RARE surgery promises to leave little Neeru with a good taste in the mouth. Born with a congenital defect in the foodpipe, the one-year-old child could not eat from the mouth. But, she will be able to eat normally in a matter of weeks. All this is possible due to gastric-tube esophagoplasty (G-t E), which has become available only at the King George's Medical University in the State. Doctors here successfully performed the rare surgery on the child, who is recuperating in the Intensive Care Unit of the Department of Paediatrics.

A RARE surgery promises to leave little Neeru with a good taste in the mouth.
Born with a congenital defect in the foodpipe, the one-year-old child could not eat from the mouth. But, she will be able to eat normally in a matter of weeks.

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All this is possible due to gastric-tube esophagoplasty (G-t E), which has become available only at the King George's Medical University in the State.

Doctors here successfully performed the rare surgery on the child, who is recuperating in the Intensive Care Unit of the Department of Paediatrics.

The G-t E is performed on children who do not have a complete esophagus, as the two ends are closed and there are gaps in between. Thus, the esophagus does not connect the mouth to the stomach. And, the child cannot take food from the mouth.

Doctors artificially make a tube by cutting the upper layer of the stomach in an oval shape. In medical terms, it is called an elliptical incision around the pit area.

The extracted layer is transformed into a tube by stitching. The stomach is also stitched back to its original shape. The artificial tube is connected to the upper end of the esophagus to make it complete.

Earlier, the surgery was performed with the help of an artificial fibre tube (shunt). But, unlike normal tissues, the tube could not grow with age. And corrective surgery was necessary whenever the tube fell short. In Neeru's case, a team of doctors formed an artificial 14-inch tube to bridge the gap between two ends.

The child was first brought to the department in 2005 with feeding problems just after birth. At that time, doctors avoided surgery on the day-old child. Instead, they gave her two artificial tubes, one of them was from the stomach (gastrostomy) for feeding. Another was connected to the esophagus with an opening towards the neck (neck esophagostomy). This was done to avoid accumulation of saliva in the closed portion of the esophagus.

She was admitted to hospital on July 17 this year and operated upon on August 2.

The operation took two-and-a-half hours against the usual four. “Taking extra precautions, we put a thin artificial tube inside the tissue tube. This has been done to avoid contraction of the tissue tube while it develops the property to contract (peristalsis) for smooth swallowing of solid food,” said Dr Ashish Wakhlu, who performed the surgery.

The child, Dr Wakhlu said, would be able to swallow food on her own in another two weeks. However, the only drawback of this operation is that the stomach becomes small due to extraction of the artificial tube.

“The stomach will also grow in a few months from now,” Dr Wakhlu said.