title: Thoracoscopic traction technique in long gap esophageal atresia: entering a new era.
abstract: OBJECTIVE
  To describe the evolution from delayed management of long gap esophageal atresia to thoracoscopic treatment directly after birth without the placement of a gastrostomy.
  
  
  BACKGROUND
  Long gap esophageal atresia remains a challenge for pediatric surgeons. Over the years, several techniques have been described to deal with the problem of the distance between the proximal and distal esophagus. More recently, a traction technique has been advocated. With the advent of minimal invasive surgery, the thoracoscopic elongation technique has been developed.
  
  
  METHODS
  Retrospective description of a single-center experience with the thoracoscopic treatment of patients with long gap esophageal atresia over a 7-year period.
  
  
  RESULTS
  Between 2007 and May 2014, 10 children with long gap esophageal atresia were treated by thoracoscopic elongation technique. In two children, the procedure failed. Eight children successfully underwent thoracoscopic traction with delayed primary anastomosis. Initially, all patients had a gastrostomy. During the course, the technique evolved into delayed primary anastomosis directly after birth without the use of a gastrostomy.
  
  
  CONCLUSIONS
  Thoracoscopic elongation technique in long gap esophageal atresia not only is feasible, but can nowadays also be performed directly after birth without the use of a gastrostomy. With this development, we have entered a new era in the management of long gap esophageal atresia.
authors: Department of Pediatric Surgery KE.04.140.5, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands. d.c.vanderzee@umcutrecht.nl.
authors: David C
authors: DC
authors: van der Zee
authors: Department of Pediatric Surgery, University Medical Center, Groningen, The Netherlands.
authors: Gabriele
authors: G
authors: Gallo
authors: Department of Pediatric Surgery KE.04.140.5, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands.
authors: Stefaan H A
authors: SH
authors: Tytgat
mesh_terms: D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D014143:Traction / Q000379:methods*; D016896:Treatment Outcome
keywords: Esophageal atresia; Long gap; Thoracoscopy; Traction technique