World Journal of Surgery

, Volume 9, Issue 2, pp 250–257 | Cite as

Esophageal atresia: Embryogenesis and management

  • Alfred A. de Lorimier
  • Michael R. Harrison
Progress Symposium—Progress in Pediatric Surgery

Abstract

The embryogenesis of esophageal atresia is reviewed. Esophageal atresia is frequently associated with other predictable anomalies and prematurity. The management of esophageal atresia will vary according to the size and vigor of the baby, the severity of complicating anomalies, and the distance between the 2 esophageal ends. Surgical repair is not urgent, since the infant can be maintained by sump suction of the proximal esophagus to prevent aspiration of mucus and by gastrostomy or jejunal feedings. When associated anomalies or pulmonary complications have been resolved, the definitive repair is performed. If there is a long distance between the esophageal ends, it is usually possible over a period of time to bring the 2 ends close together by bougie stretching and by performing a series of esophageal myotomies. Complications that should be anticipated following repair include anastomotic stricture, recurrent tracheoesophageal fistula, esophageal dysmotility, tracheomalacia, and gastroesophageal reflux with aspiration, impaired caloric intake, and esophagitis.

Résumé

L'embryogenèse de l'atrésie oesophagienne est réétudiée. L'atrésie oesophagienne est souvent associée avec d'autres anomalies et la naissance prématurée. Son traitement varie en fonction de son importance et de la vigueur du nourrisson, de la gravité des autres anomalies et de la distance entre les deux extrémités oesophagiennes normales. L'intervention chirurgicale directe d'urgence n'est pas indispensable puisque le contenu du segment supérieur de l'oesophage peut être aspiré prévenant ainsi la régurgitation intra-trachéale du mucus oesophagien et l'alimentation peut être assurée par gastrostomie ou par jéjunostomie. C'est seulement quand les anomalies associées ou les complications pulmonaires ont été traitées avec succès que l'intervention réparatrice est entreprise. Lorsque la distance qui sépare les deux extrémités de l'oesophage est importante il est habituellement possible de rapprocher celles-ci à l'aide des bougies et aussi en réalisant des myotomies oesophagiennes pendant une période de temps suffisante. Les complications à redouter après la chirurgie réparatrice sont les suivantes: sténose de l'anastomose, récidive de la fistule trachéo-oesophagienne, troubles moteurs oesophagiens, trachéomalacie, reflux gastro-oesophagien avec régurgitation, oésophagite et troubles de l'absorption alimentaire.

Resumen

Se revisa la embriogénesis de la atresia esofágica. La atresia esofágica se encuentra frecuentemente asociada con otras anomalías congénitas predecibles y con prematuridad. El manejo de la atresia esofágica varía de acuerdo al tamaño y vigor del bebé, a la gravedad de las anomalias asociadas y a la distancia entre las dos extremidades del esófago. La reparatión quirúrgica no reviste urgencia, por cuanto el paciente puede ser mantenido con succión del esófago proximal para prevenir la aspiración de moco y con alimentación por vía de gastrostomia o yeyunal.

Una vez que las anomalías asociadas o las complicaciones pulmonares hayan sido resueltas, la reparación definitiva puede ser realizada. Si existe una distancia considerable entre los extremos del esófago, es usualmente factible, en el curso de un tiempo, acercar estos extremos mediante el estiramiento con bujías y mediante la realización de una serie de miotomías esofágicas. Las complicaciones que pueden presentarse después de la reparación incluyen la estrechez de la anastomosis, la fístula traqueoesofágica recurrente, las alteraciones en la motilidad esofágica, la traqueomalacia, el reflujo gastroesofágico con aspiración, la insuficiente ingesta calórica y la esofágitis.

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Copyright information

© Société Internationale de Chirurgie 1985

Authors and Affiliations

  • Alfred A. de Lorimier
    • 1
  • Michael R. Harrison
    • 1
  1. 1.Department of Surgery, Division of Pediatric SurgeryUniversity of CaliforniaSan FranciscoUSA

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