Innovative minimally invasive gastric pull-up techniques in children: SILS and robot-assisted gastric pull-up

Aim This study aims to explore the rationality, feasibility, safety, and effectiveness of single-incision laparoscopic gastric pull-up (SILS-GPU) and robot-assisted gastric pull-up (R-GPU) methods. Methods Hospital records of patients who underwent gastric pull-up with either SILS-GPU or R-GPU between May2016 and January 2024 were reviewed. Demographics, diagnosis, surgical techniques, and postoperative outcomes were evaluated. Results Out of the total 12 patients (eight persistent corrosive esophageal stricture-PCES, four long gap esophageal atresia-LGEA), seven underwent SILS-GPU, while the remaining five underwent R-GPU. The choice of conduit route was based on the primary pathology (PCES/EA) and the presence of posterior mediastinal fibrosis and/or tracheomalacia. The posterior mediastinum was preferred in seven, intrathoracic in three, and retrosternal in two patients. Transhiatal esophagectomy was performed in seven patients, while transthoracic esophagectomy was performed in three. There were no instances of mortality or intraoperative complications related to the preferred technique. All patients except one with Down syndrome were able to feed orally. Conclusion SILS-GPU and R-GPU are demonstrated to be safe and effective in the pediatric population, with relatively lower complication rates in children.