The "wide-gap" esophageal atresia patients, on whom the esophagoesophagostomy is difficult to perform primarily, constitute 15-20 percent of the patients with congenital esophageal atresia. Circular esophagomyotomy developed by Livaditis offers a good prognosis for primary esophagoesophagostomy, in which esophagus is able to elongate at the myotomied site and overbridge the gaps between both esophageal ends. Eighty-three patients, including our six patients, who underwent the Livaditis' procedure were analyzed to determine the ideal operative indication and timing of the procedure. The results were:
1) In the patients with Gross C type of atresia, the indication of Livaditis' procedure was thought to be optimal for overbridging the gaps of 2 to 3cm if those were performed during their neonatal periods.
2) In the patients with Gross A or B types having wider gaps, the timing varied with the patients' age from three to four months to later months (around one year) depending on the degree of the effectiveness of bougienage for their preoperative esophageal elongation.
3) In the majority of patients with esophageal atresia, to whom bowel interposition had been indicated for overbridging their wider gaps, Livaditis' procedure was thought to be preferable.