title: Repair of long gap esophageal atresia without anastomosis.
abstract: OBJECTIVE
  Repair of long gap esophageal atresia represents a challenge. Several different techniques may be used. We describe 5 cases of long gap esophageal atresia managed successfully with suture approximation without anastomosis.
  
  
  METHODS
  Retrospective review identified 5 newborns (4 males; 1 female) with long gap esophageal atresia treated with suture approximation and subsequent endoscopic and fluoroscopic placement of string for guided dilatations. Three babies had esophageal atresia without fistula, and 2 had the common type with proximal atresia and distal tracheoesophageal fistula. The babies with pure esophageal atresia had delayed repair, and those with the common type had repair 2 days after birth. All had a gastrostomy for feedings.
  
  
  RESULTS
  All 5 babies recovered uneventfully. Three babies had spontaneous fistulization that allowed easy placement of guide wire and string. Two other babies required endoscopic and fluoroscopic combined fistula creation bypassing a long needle from the upper pouch to the lower one. Initially, all had string-guided dilatations that were subsequently converted to balloon dilatations. All babies had a functioning esophagus and did not need any further surgical intervention. An average of 8 postoperative dilatations were needed.
  
  
  CONCLUSIONS
  The baby's own functional esophagus is superior to any esophageal replacement. Familiarity with different techniques to preserve it is therefore important. Suture approximation without anastomosis is a safe technique that can be applied to long gap esophageal atresia. The downside of this technique is a prolonged hospital stay, multiple dilatations, prolonged fasting, and therapy to learn to eat orally.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA. gstringel@aol.com
authors.forename: Gustavo
authors.initials: G
authors.lastname: Stringel
authors.forename: Camelia
authors.initials: C
authors.lastname: Lawrence
authors.forename: Whitney
authors.initials: W
authors.lastname: McBride
mesh_terms: D002404:Catheterization; D004106:Dilatation / Q000379:methods*; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013536:Suture Techniques; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery