title: Type-A long-gap esophageal atresia treated by thoracoscopic esophagoesophagostomy after sequential extrathoracic esophageal elongation (Kimura's technique).
abstract: BACKGROUND
  We report four cases of long-gap esophageal atresia (LGEA) treated with thoracoscopic esophagoesophagostomy (TEE) after sequential extrathoracic esophageal elongation (SEEE: Kimura's technique).
  
  
  METHODS
  All initially had gastrostomy, then SEEE. The proximal end of the esophagus was introduced into the apex of the thorax under direct vision during TEE.
  
  
  RESULTS
  Mean birth weight was 1.9 kg. Mean gestational age was 35.0 weeks (range 30-39); mean age at initial esophagostomy was 43.2 days (range 15-110); SEEE was performed for a mean of 3 times (range 2-4) at mean intervals of 5.3 months (range 2-10), with the upper esophageal segment lengthened by a mean of 2.1 cm each time (range 1.1-3.5). Mean age and weight at TEE were 22.3 months and 9.8 kg, respectively. Gap was initially 4.5 vertebrae (range 4-5). Mean operating time was 9.6 h. TEE was successful in 3; 1 required thoracotomy, then re-anastomosis after 11 months of anastomosis leakage; 2 cases with post-TEE anastomosis leakage were treated conservatively. Postoperatively, all cases required fundoplication and esophageal dilatation (2, 3, 5, 8 times, respectively). At mean follow-up of 3.6 years, 2 eat normally and 2 eat minced food.
  
  
  CONCLUSIONS
  TEE after SEEE appears to be a feasible option for treating LGEA.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, go1993@hotmail.co.jp.
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Okuyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.forename: Takashi
authors.initials: T
authors.lastname: Doi
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Kazuto
authors.initials: K
authors.lastname: Suda
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D004933:Esophageal Atresia / Q000175:diagnosis / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D004946:Esophagostomy / Q000379:methods*; D004947:Esophagus / Q000002:abnormalities / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome