Abstract
Purpose: We reported long-term follow-up results on three patients with a long gap esophageal atresia repaired using circular myotomy (Livaditis method). The indication for and limitation of this method will be discussed. Materials and Methods: Between April 1980 and June 1981, three patients with long gap esophageal atresia underwent delayed primary end-to-end anastomosis using the Livaditis method. Two girls with Gross type A atresia each required one circular myotomy in the proximal esophagus to bridge the gap. A boy with Gross type B required three myotomies (one in the proximal and two in the distal esophagus) for safe anastomosis. We followed them over 20 years with regular clinical evaluation during that time. Results: All patients showed frequent episodes of respiratory infection and swallowing difficulty due mainly to anastomotic stricture during the early postoperative period. Those symptoms dramatically improved in the former two patients within three years, and have progressed smoothly thereafter. The patient with Gross type B atresia suffered from symptoms due to severe dysmotility of the repaired esophagus, necessitating resection of the poorly motile segment at the age of 19. Thus, his schooling was significantly desrupted due to repeated hospitalization over a long period. At present, one girl has graduated from college, the other girl is a university student, and the boy has his own job after graduating from junior high school. Conclusion: We conclude that the procedure achieved good long-term results in the two patients with Gross type A atresia. The procedure could even bridge an extremely long gap atresia as in our Gross type B patient. However, there does seem to be a limit to this procedure as suggested by the severe complications produced by marked dysmotility of the esophagus in the patients with three myotomies. These results, however, were seen in patients with bowel interposition.
