Abstract
The patient was born at 38 weeks and 6 days of gestation after an ultrasound scan revealed duodenal atresia. A chest X-ray showed the orogastric tube coiled in the upper esophagus at the level of the thoracic inlet and a double bubble sign at birth. Gastrostomy, esophageal banding, enterostomy, and diamond anastomosis of the duodenum were performed on day one of life. She underwent esophageal atresia involving a radical operation employing a right extrapleural thoracotomy on day 4. Then she underwent ligation of a proximal tracheoesophageal fistula located in the upper bifurcation of the trachea. After the mobilization of both ends with maximal tension, there remained a 2.5cm gap; therefore, we applied external traction using Foker's technique. Daily traction (1-2mm/day) at both esophageal ends was started on day 8, following the release of esophageal banding on day 7. An intrathoracic drain for the right pneumothorax was inserted on day 14. We performed esophageal anastomosis under thoracotomy on day 16. Postoperatively, she showed minor leakage which resolved with conservative management. The anastomotic stricture responded well to balloon dilation and the gastroesophageal reflux was controlled by fundoplication. She could swallow food orally after the operation. External traction using Foker's technique induced elongation of the esophageal segments within days, facilitating the primary repair of the long gap.
