Esophago-Esophagostomy for Long Gap Esophageal Atresia

Abstract

The authors analyzed the outcome for 55 infants with esophageal atresia and 5 with long gap atresia treated from 1983 through 2005. Of these 5 long gap cases, there are 2 Gross A type, one Gross B type and 2 Gross C type atresia. The length of gap measured from 25 mm to longer than 35 mm. We applied the elongation technique of the upper pouch according to the Howard-Myers method in 4 of the 5 cases. In 3 of the 4 Howard-Myers' elongation cases, we performed esophago-esophagostomy when both upper and lower pouch elongated enough to cross over. The other case of elongation, complicated by severe congenital heart disease, received repair of heart diseases primarily followed by secondary repair of esophageal atresia using the Rehbein-Kato method at the age of 7 years old. One case received cervical esophagostomy by another surgeon, who applied multi-staged extrathoracic elongation of upper part of the esophagus; then we performed esophago-esophagostomy. All 5 cases were complicated by postoperative anastomotic stenosis and required dilatation. Two of 3 cases followed up for more than 10 years are doing well and have no complaints, whereas the other case of B type tracheoesophageal fistura was complicated by gastroesophageal reflux and required fundoplication. The case is under training in swallowing. We think that it is safe and possible to anastomose patients' own esophagus despite anastomotic stenosis even in cases of long gap esophageal atresia.