title: Treatment and Follow-Up of Patients with Long-Gap Esophageal Atresia: 15 Years' of Experience from the Western Region of Sweden.
abstract: OBJECTIVE
  This retrospective study aims to report treatment results in patients with long-gap esophageal atresia (LGEA), gross A + B type, and discuss the value of different clinical findings and physiological tests in the follow-up.
  
  
  METHODS
  This retrospective observational study comprises all patients with LGEA admitted to our department between 1995 and 2010.
  
  
  RESULTS
  A total of 16 patients were included. Their mean gestational age was 35(+2) weeks and their mean birth weight was 1,945 g (-2.5 standard deviation scores). No catch-up growth in height could be seen and they remained smaller than the average population during the study period. Gastrostomy was performed as the first surgical procedure. Overall, 11 of the 16 patients had a delayed primary anastomosis. Elongation of the distal esophageal segment was required in 3 of the 16 patients and a colonic interposition in 2 of the 16 patients. The median age at definitive surgery was 150 days. All the patients had gastroesophageal reflux after their definitive surgery. Three of the 16 patients required surgery due to aspiration and all 3 had a pathological lung clearance index (LCI) at multiple-breath washout (MBW). At the age of 1 or 7 years, the LCI was pathological in 4 of the 14 patients, and spirometry showed an obstruction in 9 of the 14 patients.
  
  
  CONCLUSIONS
  LGEA is a severe congenital malformation, with severe morbidity. No mortality was seen. MBW could be a useful tool for the early detection of progressive pulmonary damage.
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Linus
authors.initials: L
authors.lastname: Jönsson
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Lars Göran
authors.initials: LG
authors.lastname: Friberg
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Gatzinsky
authors.affiliation: Department of Pediatrics, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Karsten
authors.initials: K
authors.lastname: Kötz
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Ulla
authors.initials: U
authors.lastname: Sillén
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Kate
authors.initials: K
authors.lastname: Abrahamsson
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak; D001999:Bronchoscopy; D002648:Child; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D005774:Gastrostomy; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008171:Lung Diseases / Q000150:complications; D008297:Male; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D013147:Spirometry; D013548:Sweden
chemical_list: D054328:Proton Pump Inhibitors