Lengthening technique for long gap esophageal atresia and early anastomosis.
OBJECTIVE
The treatment of long gap esophageal atresia remains a major surgical challenge. Whereas many approaches have been used for this problem, none are ideal. The authors used a technique originally described by Dr John E. Foker and accomplished early repair in 3 infants with long gap atresia.


METHODS
Three infants with esophageal atresia underwent thoracotomy shortly after birth and had a long gap preventing primary anastomosis. External traction sutures were placed on each esophageal pouch and exteriorized through the thoracic wall. The esophageal ends were approximated 1 to 2 mm daily by traction on the sutures. Anastomosis was performed when the 2 ends came together.


RESULTS
Three infants were included (31, 34, 37 weeks gestation, weights 1.38 kg, 1.9 kg, and 2.3 kg, respectively). The esophageal gaps were 3, 5, and 4.5 cm, respectively. Definitive anastomosis was performed at 14, 17, and 10 days, respectively. Two patients had anastomotic leaks that were treated conservatively. One patient had an esophageal stenosis that required dilatation.


CONCLUSIONS
This technique allowed rapid esophageal lengthening in these 3 cases and led to early repair of long gap esophageal atresia, avoiding the need for a prolonged hospitalization or eventual replacement as well as long-term swallowing difficulties.
Hôpital Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada, and the Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Aayed R
AR
Al-Qahtani
Salam
S
Yazbeck
Nelson G
NG
Rosen
Sami
S
Youssef
Sandeep K
SK
Mayer
D000714:Anastomosis, Surgical / Q000379:methods; D004106:Dilatation; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy; D004944:Esophagoplasty / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male