title: Multistaged extrathoracic esophageal elongation procedure for long gap esophageal atresia: Experience with 12 patients.
abstract: OBJECTIVE
  This study evaluates the multistaged extrathoracic esophageal elongation procedure performed on 12 babies with long gap esophageal atresia over 15 years.
  
  
  METHODS
  Eight babies had pure esophageal atresia, 2 had proximal tracheoesophageal fistula (TEF), and 2 had distal TEF. The gaps ranged between 2 and 7 vertebral bodies. Proximal esophagostomy, TEF ligation, and gastrostomy were performed initially. The proximal esophagus is elongated 2 to 3 cm each time by translocating the esophagostomy distally along the anterior chest wall at 2- to 3-month intervals. Sham-fed milk is collected in an ostomy bag and refed via the gastrostomy. The definitive esophageal reconstruction is performed at 5 to 24 months of age.
  
  
  RESULTS
  Only one elongation was required in 4 babies, 2 were needed in 5, 3 in 2, and 5 in 1 patient. All patients tolerated sham feeding well. After esophageal restoration, 3 patients had minor leakage. All (12 of 12) patients had anastomotic stenosis requiring multiple dilatations, of which, 3 needed resection of stricture. Eleven patients had gastroesophageal reflux that required fundoplication. Follow-up was possible in 11 patients for 4 months to 14 years after esophageal restoration. Seven early patients are eating normally.
  
  
  CONCLUSIONS
  Multistaged extrathoracic esophageal elongation is effective in stretching the proximal esophagus to bridge 2 to 7 vertebral bodies.
authors.affiliation: Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
authors.forename: K
authors.initials: K
authors.lastname: Kimura
authors.forename: E
authors.initials: E
authors.lastname: Nishijima
authors.forename: C
authors.initials: C
authors.lastname: Tsugawa
authors.forename: D L
authors.initials: DL
authors.lastname: Collins
authors.forename: E L
authors.initials: EL
authors.lastname: Lazar
authors.forename: S
authors.initials: S
authors.lastname: Stylianos
authors.forename: A
authors.initials: A
authors.lastname: Sandler
authors.forename: R T
authors.initials: RT
authors.lastname: Soper
mesh_terms: D002675:Child, Preschool; D004933:Esophageal Atresia / Q000601:surgery*; D004946:Esophagostomy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D008297:Male; D012086:Reoperation; D014138:Tracheoesophageal Fistula / Q000601:surgery*