Abstract
In newborns with long-gap esophageal atresia, the esophageal segments are too far apart to allow primary anastomosis. Spontaneous growth and hypertrophy of the two esophageal segments occur at a rate faster than overall somatic growth in the absence of any form of mechanical stretching. The maximal natural growth arises in the first 8–12 weeks of life. The stimuli are the swallowing reflex and the reflux of gastric contents into the lower esophageal pouch. Therefore, initial gastrostomy and continuous suction of the upper esophageal pouch followed by delayed primary anastomosis is an ideal procedure for the management of newborns with long-gap esophageal atresia and provides good long-term functional results.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Depaepe A, Dolk H, Lechat MF. The epidemiology of tracheo-oesophageal fistula and oesophageal atresia in Europe. EUROCAT Working Group. Arch Dis Child. 1993;68:743–8.
Torfs CP, Curry CJ, Bateson TF. Population-based study of tracheoesophageal fistula and esophageal atresia. Teratology. 1995;52:220–32.
Manning PB. Long-gap esophageal atresia. Semin Thorac Cardiovasc Surg. 1994;6:216–20.
Langer JC, et al. Prenatal diagnosis of esophageal atresia using sonography and magnetic resonance imaging. J Pediatr Surg. 2001;36:804–7.
Stringer MD, et al. Prenatal diagnosis of esophageal atresia. J Pediatr Surg. 1995;30:1258–63.
Ladd WE. The surgical treatment of esophageal atresia and tracheoesophageal fistulas. N Engl J Med. 1944;230:625–37.
Haight C, Towsley HA. Congenital atresia of esophagus with tracheoesophageal fistula: extrapleural ligation and end-to-end anastomosis of esophageal segments. Surg Gynecol Obstet. 1943;76:672–88.
Orford J, Cass DT, Glasson MJ. Advances in the treatment of oesophageal atresia over three decades: the 1970s and the 1990s. Pediatr Surg Int. 2004;20:402–7.
Goyal A, et al. Oesophageal atresia and tracheo-oesophageal fistula. Arch Dis Child Fetal Neonatal Ed. 2006;91:381–4.
Chittmittrapap S, et al. Oesophageal atresia and associated anomalies. Arch Dis Child. 1989;64:364–8.
Myers NA. Oesophageal atresia. Pediatr Surg Int. 1992;7:83–5.
Holland AJ, et al. Surgical outcomes of esophageal atresia without fistula for 24 years at a single institution. J Pediatr Surg. 2009;44:1928–32.
Ron O, De Coppi P, Pierro A. The surgical approach to esophageal atresia repair and the management of long-gap atresia: results of a survey. Semin Pediatr Surg. 2009;18:44–9.
Myers NA. Oesophageal atresia: the epitome of modern surgery. Ann R Coll Surg Engl. 1974;54:277–87.
Howard R, Myers NA. Esophageal atresia: a technique for elongating the upper pouch. Surgery. 1972;71:661–4.
Lafer DJ, Boley SJ. Primary repair in esophageal atresia with elongation of the lower segment. J Pediatr Surg. 1966;1:585–7.
Rehbein F, Schweder N. Reconstruction of the esophagus without colon transplantation in cases of atresia. J Pediatr Surg. 1971;6:746–52.
Thomasson BH. Congenital esophageal atresia: mercury bag stretching of the upper pouch in a patient without tracheoesophageal fistula. Surgery. 1972;71:661–3.
Livaditis A, Radberg L, Odensjo G. Esophageal end-to-end anastomosis: reduction of anastomotic tension by circular myotomy. Scand J Thorac Cardiovasc Surg. 1972;6:206–14.
Shafer AD, David TE. Suture fistula as a means of connecting upper and lower segments in esophageal atresia. J Pediatr Surg. 1974;9:669–73.
Hendren WH, Hale JR. Esophageal atresia treated by electromagnetic bougienage and subsequent repair. J Pediatr Surg. 1976;11:713–22.
Puri P, et al. Delayed primary anastomosis following spontaneous growth of esophageal segments in esophageal atresia. J Pediatr Surg. 1981;16:180–3.
Puri P, et al. Delayed primary anastomosis for esophageal atresia: 18 months’ to 11 years’ follow-up. J Pediatr Surg. 1992;27:1127–30.
Boyle Jr EM, Irwin ED, Foker JE. Primary repair of ultra-long-gap esophageal atresia: results without a lengthening procedure. Ann Thorac Surg. 1994;57:576–9.
Foker JE, et al. Development of a true primary repair for the full spectrum of esophageal atresia. Ann Surg. 1997;226:533–41.
Beasley SW, Myers NA, Auldist AW. Visualisation of the inferior pouch in oesophageal atresia without fistula. Pediatr Surg Int. 1999;15:451.
Rossi C, et al. A simple and safe method to visualize the inferior pouch in esophageal atresia without fistula. Pediatr Surg Int. 1998;13:535–6.
Puri P, Khurana S. Delayed primary esophageal anastomosis for pure esophageal atresia. Semin Pediatr Surg. 1998;7:126–9.
Caffarena PE, et al. Long-gap oesophageal atresia: a combined endoscopic and radiologic evaluation. Eur J Pediatr Surg. 1994;4:67–9.
Chan KL, Saing H. Combined flexible endoscopy and fluoroscopy in the assessment of the gap between the two esophageal pouches in esophageal atresia without fistula. J Pediatr Surg. 1995;30:668–70.
Gross ER, et al. The role of fiberoptic endoscopy in the evaluation and management of long gap isolated esophageal atresia. Pediatr Surg Int. 2010;26:1223–7.
Ratan SK, et al. Evaluation of neonates with esophageal atresia using chest CT scan. Pediatr Surg Int. 2004;20:757–61.
Tam PK, Chan FL, Saing H. Diagnosis and evaluation of esophageal atresia by direct sagittal CT. Pediatr Radiol. 1987;17:68–70.
Aziz D, et al. Can “long-gap” esophageal atresia be safely managed at home while awaiting anastomosis? J Pediatr Surg. 2003;38:705–8.
Ein SH, Shandling B, Heiss K. Pure esophageal atresia: outlook in the 1990s. J Pediatr Surg. 1993;28:1147–50.
Sri Paran T, et al. Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up. Pediatr Surg Int. 2007;23:647–51.
Rosinha MC, et al. Delayed primary anastomosis for esophageal atresia without fistulae: 10 years of experience. Acta Med Port. 1997;10:173–7.
Yeh SH, et al. Use of retrograde esophagoscopy in delayed primary esophageal anastomosis for isolated esophageal atresia. Eur J Pediatr Surg. 2010;20:40–4.
Howell CG, Davis Jr JB, Parrish RA. Primary repair of esophageal atresia: how long a gap? J Pediatr Surg. 1987;22:42–3.
Lobe TE, et al. Thoracoscopic repair of esophageal atresia in an infant: a surgical first. Pediatric Endosurg Innovative Tech. 1999;3:141–8.
Buonuomo V, et al. Esophageal atresia: personal experience and review of the literature. Ann Ital Chir. 2007;78:385–8.
Cavallaro S, et al. Feeding troubles following delayed primary repair of esophageal atresia. Eur J Pediatr Surg. 1992;2:73–7.
de la Hunt MN, Fleet MS, Wagget J. Delayed primary anastomosis for wide-defect esophageal atresia: a 17-year experience. Pediatr Surg Int. 1994;9:21–3.
Healey PJ, et al. Delayed primary repair of esophageal atresia with tracheoesophageal fistula: is it worth the wait? Arch Surg. 1998;133:552–6.
Lindahl H, Rintala R, Louhimo I. Oesophageal anastomosis without bougienage in isolated atresia – do the segments really grow while waiting? Z Kinderchir. 1987;42:221–3.
Rescorla FJ, et al. The complex nature of type A (long-gap) esophageal atresia. Surgery. 1994;116:658–64.
Bensoussan AL, Letourneau JN, Blanchard H. Long gap esophageal atresia types 1 and 2 by delayed primary anastomosis: report on 6 cases. Chir Pediatr. 1983;24:109–12.
Burjonrappa S, et al. Type a esophageal atresia: a critical review of management strategies at a single center. J Pediatr Surg. 2010;45:865–71.
Golonka NR, Hayashi AH. Early “sham” feeding of neonates promotes oral feeding after delayed primary repair of major congenital esophageal anomalies. Am J Surg. 2008;195:659–62.
Hagberg S, et al. Management of long-gap esophagus: experience with end-to-end anastomosis under maximal tension. Prog Pediatr Surg. 1986;19:88–92.
Hicks LM, Mansfield PB. Esophageal atresia and tracheoesophageal fistula: review of thirteen years’ experience. J Thorac Cardiovasc Surg. 1981;81:358–63.
Ito T, Sugito T, Nagaya M. Delayed primary anastomosis in poor-risk patients with esophageal atresia associated with tracheoesophageal fistula. J Pediatr Surg. 1984;19:243–7.
Santos AD, et al. Correction of esophageal atresia with distal tracheoesophageal fistula. J Thorac Cardiovasc Surg. 1983;85:229–36.
Wise Jr WE, Caniano DA, Harmel Jr RP. Tracheoesophageal anomalies in Waterston C neonates: a 30-year perspective. J Pediatr Surg. 1987;22:526–9.
Bagolan P, et al. Long gap esophageal atresia and esophageal replacement: moving toward a separation? J Pediatr Surg. 2004;39:1084–90.
Gurskas P, Ivanauskas A. Delayed primary anastomosis for esophageal atresia. Medicina. 2004;40:166–9.
Hight DW, et al. Atresia of the esophagus: new trends in the management of high-risk neonates. Arch Surg. 1987;122:421–3.
Myers NA, et al. Oesophageal atresia without fistula – anastomosis or replacement? Pediatr Surg Int. 1987;2:216–22.
Ruiz de Temino M, et al. Esophageal atresia type I: is impossible possible? Cir Pediatr. 2006;19:39–45.
Pieretti R, Shandling B, Stephens CA. Resistant esophageal stenosis associated with reflux after repair of esophageal atresia: a therapeutic approach. J Pediatr Surg. 1974;9:355–7.
Seguier-Lipszyc E, et al. The management of long gap esophageal atresia. J Pediatr Surg. 2005;40:1542–6.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Puri, P., Friedmacher, F. (2017). Delayed Primary Anastomosis in the Management of Long-Gap Esophageal Atresia. In: Till, H., Thomson, M., Foker, J., Holcomb III, G., Khan, K. (eds) Esophageal and Gastric Disorders in Infancy and Childhood. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11202-7_21
Download citation
DOI: https://doi.org/10.1007/978-3-642-11202-7_21
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-11201-0
Online ISBN: 978-3-642-11202-7
eBook Packages: MedicineMedicine (R0)