, Volume 16, Issue 1, pp 93–97 | Cite as

A new esophageal elongation technique for long-gap esophageal atresia: in vitro comparison of myotomy techniques

  • Burhan Beger
  • Orhan BegerEmail author
Original Article



Complications such as stricture, leakage, recurrent tracheoesophageal fistula and mucosal pouch are commonly seen in myotomy techniques used for long-gap esophageal atresia (LGEA) treatments. Therefore, we think that there is a clear need for other techniques which would enable us to create more robust and longer esophagus in such cases. In this study, we reviewed multiple V-myotomy (VM) technique and the differences of the said technique with Livaditis circular myotomy (LM) and Kimura spiral myotomy (KM) techniques using literature as an aid.


21 esophagus samples from 21 male lambs aged 12 months were used in vitro for the study. All esophageal samples were matched to have a length of 120 mm. Samples were divided into 3 groups of 7 and VM, LM and KM techniques were used in each group, respectively. Post-op esophagus lengths, elongation amount with each incision and perforation pressures were measured.


Post-op esophageal lengths were measured as 227, 210 and 200 mm for VM, LM and KM, respectively. Elongation amount per incision was measured as 5.1, 4 and 3.34 mm, again in previous order of VM, LM, and KM. Finally, perforation pressure following VM, LM, and KM was measured as 460, 400, and 410 mmHg.


VM was found to significantly increase total esophagus length and elongation per incision over LM and KM. In addition, VM was also shown to have a higher perforation pressure. Although in vivo live animal studies are required, we can say that VM can be used to create longer and robust esophagus.


Esophagus atresia Kimura technique Livaditis technique Long-gap esophagus atresia Newborn 



We thank Atilla Bayram for the illustration.

Author contributions

BB project development, data collection, data analysis, manuscript writing, and manuscript editing. OB data collection, data analysis, and manuscript writing.



Compliance with ethical standards

Ethical Statement

As esophagus samples were collected from a slaughterhouse, no ethics committee approval was required due to legal procedures in our country.

Conflict of interest

B.B and O.B have no conflict of interest or financial ties to disclose.


  1. 1.
    Al-Shanafey S, Harvey J. Long gap esophageal atresia: an Australian experience. J Pediatr Surg. 2008;43(4):597–601.CrossRefGoogle Scholar
  2. 2.
    Singh A, Bajpai M, Sharma N, et al. Experience with Livaditis circular myotomy in management of long gap TEF. Afr J Paediatr Surg. 2014;11(1):35–8.CrossRefGoogle Scholar
  3. 3.
    Ein SH. Surgical methods to increase esophageal length in long (wide)-gap esophageal atresia with and without tracheoesophageal fistula. Esophageal Gastric Disord Infancy Child. 2017. Scholar
  4. 4.
    Sun S, Pan W, Wu W, et al. Elongation of esophageal segments by bougienage stretching technique for long gap esophageal atresia to achieve delayed primary anastomosis by thoracotomy or thoracoscopic repair: a first experience from China. J Pediatr Surg. 2017. Scholar
  5. 5.
    Tainaka T, Uchida H, Tanano A, et al. Two-stage thoracoscopic repair of long-gap esophageal atresia using internal traction is safe and feasible. J Laparoendosc Adv Surg Tech A. 2017;27(1):71–5.CrossRefGoogle Scholar
  6. 6.
    Tamburri N, Laje P, Boglione M, et al. Extra thoracic esophageal elongation (Kimura’s technique): a feasible option for the treatment of patients with complex esophageal atresia. J Pediatr Surg. 2009;44(12):2420–5.CrossRefGoogle Scholar
  7. 7.
    Uygun I, Zeytun H, Otcu S. Immediate primary anastomosis for isolated oesophageal atresia: a single-centre experience. Afr J Paediatr Surg. 2015;12(4):273–9.CrossRefGoogle Scholar
  8. 8.
    Al-Qahtani AR, Yazbeck S, Rosen NG, et al. Lengthening technique for long gap esophageal atresia and early anastomosis. J Pediatr Surg. 2003;38(5):737–9.CrossRefGoogle Scholar
  9. 9.
    Melek M, Cobanoglu U. A new technique in primary repair of congenital esophageal atresia preventing anastomotic stricture formation and describing the opening condition of blind pouch: plus (+) incision. Gastroenterol Res Pract. 2011. Scholar
  10. 10.
    Sharma AK, Mangal D. Simple technique of bridging wide gap in esophageal atresia with tracheoesophageal fistula–“surgical innovation”. J Indian Assoc Pediatr Surg. 2017;22(3):187–8.CrossRefGoogle Scholar
  11. 11.
    Chumfong I, Lee H, Padilla BE, et al. Esophagoesophagopexy technique for assisted fistulization of esophageal atresia. Pediatr Surg Int. 2018;34(1):63–9.CrossRefGoogle Scholar
  12. 12.
    Tannuri U, Tannuri ACA, Fukutaki MF, et al. Effects of circular myotomy on the healing of esophageal suture anastomosis: an experimental study. Rev Hosp Clin Fac Med Sao Paulo. 1999;54(1):9–16.CrossRefGoogle Scholar
  13. 13.
    Kimura K, Nishijima E, Tsugawa C, et al. Multi staged extra thoracic esophageal elongation procedure for long gap esophageal atresia: experience with 12 patients. J Pediatr Surg. 2001;36(11):1725–7.CrossRefGoogle Scholar
  14. 14.
    Mochizuki K, Shinkai M, Take H, et al. Impact of an external lengthening procedure on the outcome of long-gap esophageal atresia at our hospitals. Pediatr Surg Int. 2015;31(10):937–42.CrossRefGoogle Scholar
  15. 15.
    Giacomoni MA, Tresoldi M, Zamana C, et al. Circular myotomy of the distal esophageal stump for long gap esophageal atresia. J Pediatr Surg. 2001;36(6):855–7.CrossRefGoogle Scholar
  16. 16.
    Shieh HF, Jennings RW. Long-gap esophageal atresia. Semin Pediatr Surg. 2017;26(2):72–7.CrossRefGoogle Scholar
  17. 17.
    Lai JY, Sheu JC, Chang PY, et al. Experience with distal circular myotomy for long-gap esophageal atresia. J Pediatr Surg. 1996;31(11):1503–8.CrossRefGoogle Scholar
  18. 18.
    Livaditis A, Björck G, Kängström LE. Esophageal myectomy: an experimental study in piglets. Scand J Thorac Cardiovasc Surg. 1969;3(2):181–5.CrossRefGoogle Scholar

Copyright information

© The Japan Esophageal Society and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryVan Yüzüncü Yıl University Faculty of MedicineVanTurkey
  2. 2.Department of AnatomyMersin University Faculty of MedicineMersinTurkey

Personalised recommendations