Circular myotomy was required in two patients with esophageal atresia to achieve an tension-free end-to-end esophageal anastomosis. One case on whom the blunt dissection of muscle layer at myotomy site was performed, developed a marked ballooning at the site of myotomy causing recurrent aspiration pneumonias. The other case on whom simple circular myotomy without further procedure was performed, did not develop esophageal dilatation and showed a good postoperative course despite poor lower esophageal clearance. The ballooning at myotomy site causes poor emptying of the esophagus and when concomitant gastroesophageal reflux, anastomotic strictue or poor motility of lower esophagus are present, they aggravate esophageal stasis and lead to the occurrence of dysphagia and trouble-some repeated aspiraton pneumonia. Therefore, it seems important to avoid the muscular dissection at Livaditis operation to keep the amuscular segment short.
