Two high risk cases of esophageal atresia with distal tracheoesophageal fistula (group C of Waterston's classification) were successfully treated by silastic banding of the distal esophagus. This procedure is thought to be safer than the Holder's original extrapleural fistula division and useful in the management of premature or critically ill babies with esophageal atresia. Unfortunately both patients died of sepsis three months after operation. Autopsies showed esophagea stricture and weakness of the esophogeal wall at the banding site. Histological studies showed dissection of the external longitudinal muscle layer and proliferation of the collagen fibers at the banding site. It was suspected that the factors providing pathological changes at the banded esophageal wall are related to tightness and duration and the materials used for banding. It is concluded that a loose banding is safer and satisfactory for prevention of gastric reflux.
