Skip to main content
SpringerLink
Log in

Long-gap oesophageal atresia

  • Original Articles
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

The various options for the management of long-gap oesophageal atresia are discussed. Of 89 infants treated, 27 had isolated atresia, 6 distal atresia with proximal fistula, and 56 atresia with distal fistula. The preferred approach for the former two groups was oesophageal replacement via gastric transposition. Recently, delayed primary anastomosis has been attempted after 6–12 weeks. For wide-gap atresia with distal fistula, primary anastomosis under marked or extreme tension with elective paralysis and mechanical ventilation for 5 days postoperatively achieved highly successful results in 39 infants. There were no major anastomotic disruptions and only 7 minor leaks. Strictures developed in 72% of cases and gastro-oesophageal reflux in 54%, 66% of whom required antireflux surgery. There was only 1 death in the 43 patients undergoing oesophageal replacement (none after gastric transposition, n = 34). A highly satisfactory outcome was achieved in 85%–90% of infants undergoing a replacement procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hagberg S, Rubenson A, Sillen U, Werkmaster K (1986) Management of Long-gap esophagus: experience with ent-to-end anastomosis under maximal tension. Prog Pediatr Surg 19: 88–92

    Article  PubMed  CAS  Google Scholar 

  2. MacKinley GA, Burtles R (1987) Oesophageal atresia: paralysis and ventilation in management of long gap. Pediatr Surg Int 2: 10–12

    Google Scholar 

  3. Spitz L, Kiely E, Brereton RJ, Drake D (1993) Management of esophageal atresia. World J of Surg 17: 296–300

    Article  CAS  Google Scholar 

  4. Lividitis A (1973) Esophageal atresia: a method of overbridging large segment gaps. Z Kinderchir 13: 298–306

    Google Scholar 

  5. Eraklis AJ, Rosello PJ, Ballantine TVN (1976) Circular esophagomyotomy of upper pouch in primary repair of long-segment esophageal atresia. J Ped Surg 11: 709–712

    Article  CAS  Google Scholar 

  6. Vizas D, Ein SH, Simpson JS (1978) The value of circular myotomy for esophageal atresia. J Ped Surg 13: 357–359

    Article  CAS  Google Scholar 

  7. Hoffman DG, Moazam F (1984) Transcervical myotomy for widegap esophageal atresia. J Ped Surg 19: 680–682

    Article  CAS  Google Scholar 

  8. Gough MH (1980) Esophageal atresia — use of an anterior flap in the difficult anastomosis. J Ped Surg 15: 310–311

    Article  CAS  Google Scholar 

  9. Davenport M, Bianchi A (1990) Early experience with oesophageal flap oesophagoplasty for repair of oesophageal atresia. Pediatr Surg Int 5: 332–335

    Article  Google Scholar 

  10. Rehbein F, Schweder N (1971) Reconstruction of the esophagus without colon transplantation in cases of atresia. J Ped Surg 6: 746–752

    Article  CAS  Google Scholar 

  11. Shafer AD, David TE (1974) Suture fistula as a means of connecting upper and lower segments in esophageal atresia. J Ped Surg 9: 669–673

    Article  CAS  Google Scholar 

  12. Schullinger JN, Vinocur CD, Santulli TV (1982) The suture fistula technique in the repair of selected cases of esophageal atresia. J Ped Surg 17: 234–236

    Article  CAS  Google Scholar 

  13. Howard R, Myers NA (1965) Esophageal atresia: a technique for elongating the upper pouch. Surgery 58: 725–739

    Google Scholar 

  14. Mahour GH, Woolley MM, Gwinn JL (1974) Elongation of the upper pouch and delayed anatomic reconstruction in esophageal atresia. J Ped Surg 9: 373–383

    Article  CAS  Google Scholar 

  15. Hays DM, Woolley MM, Snyder WH (1966) Changing techniques in the management of esophageal atresia. Arch Surg 92: 611–616

    Article  PubMed  CAS  Google Scholar 

  16. Hendren WH, Hale JR (1975) Electromagnetic bougienage to lengthen esophageal segments in congenital esophageal atresia. N Engl J Med 293: 428–432

    Article  PubMed  CAS  Google Scholar 

  17. Puri P, Blake N, O'Donnell B, Guiney EJ (1981) Delayed primary anastomosis following spontaneous growth of esophageal segments in esophageal atresia. J Ped Surg 16: 180–183

    Article  CAS  Google Scholar 

  18. Rossello PJ, Lebron H, Roman Franco AA (1980) The techniques of myotomy in esophageal reconstruction: an experimental study. J Ped Surg 15: 430–432

    Article  CAS  Google Scholar 

  19. Kimura K, Nishijima E, Tsugawa C, Matsumoto Y (1987) A new approach for the salvage of unsuccessful esophageal atresia repair: a spiral myotomy and elayed definitive operation. J Ped Surg 22: 981–983

    Article  CAS  Google Scholar 

  20. Schärli AF (1992) Esophageal reconstruction in very long atresias by elongation of the lesser curvature. Pediatr Surg Int 7: 101–105

    Article  Google Scholar 

  21. Okmian L, Boss D, Ekelund L (1975) An endoscopic technique for Rehbein's silver-olive method. Z Kinderchir 16: 212–215

    Google Scholar 

  22. Kato T, Hollmann G, Hopner F, Ohashi E, Hecker WC (1980) Ein neues Instrument zur Fadenlegung ohne Thorakotomie in ausgewählten Fällen von Osophagusatresie. Z Kinderchir 6: 206–214

    Google Scholar 

  23. Waterston D (1964) Colonic replacement of esophagus (intrathoracic). Surg Clin North Am 44: 1441

    Google Scholar 

  24. Freeman NV, Cass DT (1982) Colon interposition. A modification of the Waterston technique using the normal oesophageal route. J Pediatr Surg 17: 17–21

    Article  PubMed  CAS  Google Scholar 

  25. Heimlich HJ (1966) Elective replacement of the oesophagus. Br J Surg 53: 913

    Article  PubMed  CAS  Google Scholar 

  26. Anderson KD, Randolph JG (1973) The gastric tube for esophageal replacement in infants and children. J Thor Cardiovasc Surg 66: 333

    CAS  Google Scholar 

  27. Ring WS, Varco RL, L'Heureux PR, Foker JE (1982) Esophageal replacement with jejunum in children. An 18- to 33-year follow-up. J Thorac Cardiovasc Surg 83: 918

    PubMed  CAS  Google Scholar 

  28. Spitz L (1984) Gastric transposition via the mediastinal route for infants with long-gap esophageal atresia. J Pediatr Surg 19: 149–154

    Article  PubMed  CAS  Google Scholar 

  29. Spitz L (1992) Gastric transposition for esophageal substitution in children. J Pediatr Surg 27: 252–259

    Article  PubMed  CAS  Google Scholar 

  30. Haller JA, Broker AF, Talbert JL (1966) Esophageal function following resection. Studies in newborn puppies. Ann Thor Surg 2: 180–187

    Article  Google Scholar 

  31. Burgess JN, Carlson HC, Ellis FJ Jr (1968) Esophageal function after successful repair of esophageal atresia and tracheo-esophageal fistula — a manometric and cine-fluorographic study. J Thorax Cardiovasc Surg 56: 667–673

    CAS  Google Scholar 

  32. Laks H, Wilkinson RH, Schuster SR (1972) Long-term results following correction of esophageal atresia with tracheoesophageal fistula. A clinical and cine-fluorographic study. J Pediatr Surg 7: 591–597

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Great Ormond Street Hospital for Children, London, UK

    L. Spitz, E. M. Kiely, D. P. Drake & A. Pierro

  2. Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK

    L. Spitz

Authors
  1. L. Spitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. M. Kiely
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. P. Drake
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Pierro
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spitz, L., Kiely, E.M., Drake, D.P. et al. Long-gap oesophageal atresia. Pediatr Surg Int 11, 462–465 (1996). https://doi.org/10.1007/BF00180083

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00180083

Key words

Search

Navigation