title: Repair of long-gap esophageal atresia: gastric conduits may improve outcome-a 20-year single center experience.
abstract: BACKGROUND
  Treatment of long-gap esophageal atresia (LEA) is a major challenge. Options for reconstruction include native esophagus, or replacement with stomach, colon, or small intestine. However, debate continues regarding the optimal conduit for esophageal replacement.
  
  
  METHODS
  Medical records of patients with a diagnosis of esophageal atresia during a 20-year period were reviewed.
  
  
  RESULTS
  Twenty-eight cases of LEA were identified. Ten patients underwent primary anastomosis either after serial pouch dilations (9/10) and/or after a lengthening procedure (2/10). Nine received colonic interpositions, and the remainder were reconstructed with a gastric tube (n = 3), or gastric interposition (n = 2). One patient died prior to repair, and two await definitive treatment. Repeat esophageal reconstruction was required in four patients because of conduit ischemia. Two ischemic events occurred in the colonic interposition group, and two in the native esophageal repairs. All patients, except one who relocated, received long-term follow-up (mean 4.2 years: range 0.5-11.5 years).
  
  
  CONCLUSIONS
  Surgeon's expertise and patient's anatomy should be considered when selecting an appropriate operation for LEA. Although native esophagus is generally preferred, it is associated with a high rate of stricture. Although our study has a limited by numbers, we found that patients with gastric conduits had lower complication rates and no conduit ischemia. We suggest that gastric transposition may be favored as an initial reconstructive option.
authors.affiliation: Childrens Hospital Los Angeles, Los Angeles, USA.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Hunter
authors.forename: Mikael
authors.initials: M
authors.lastname: Petrosyan
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Connelly
authors.forename: Henri R
authors.initials: HR
authors.lastname: Ford
authors.forename: Nam X
authors.initials: NX
authors.lastname: Nguyen
mesh_terms: D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery
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