Gastric dissociation for the treatment of congenital microgastria with paraesophageal hiatal hernia

Microgastria is a rare but well-described congenital anomaly of the alimentary tract that presents in the neonatal period with vomiting, aspiration, and failure to thrive. Based on a relatively small number of case reports, gastric augmentation with a double-barrel loop of jejunum, known as a Hunt-Lawrence pouch, has been advocated as the reconstructive procedure of choice in affected children who fail nonoperative management. In this report, we present a novel method of foregut reconstruction in an infant with congenital microgastria and a paraesophageal hiatal hernia. In this procedure, the stomach was transected 1 cm below the gastroesophageal junction with construction of a straight Roux-en-Y jejunal anastomosis to the gastric fundic cuff. A feeding gastrostomy tube was placed into the distal remnant stomach for enteral access. The patient did well and eventually transitioned to full oral feeds by 3 years of age.