Multistaged extrathoracic esophageal elongation procedure for long gap esophageal atresia: Experience with 12 patients.
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.
Kimura
K
K
Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
Nishijima
E
E
Tsugawa
C
C
Collins
D L
DL
Lazar
E L
EL
Stylianos
S
S
Sandler
A
A
Soper
R T
RT
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*