Surgery Today

, Volume 43, Issue 8, pp 906–909 | Cite as

Successful two-stage thoracoscopic repair of long-gap esophageal atresia using simple internal traction and delayed primary anastomosis in a neonate: report of a case

  • Yujiro Tanaka
  • Hiroo UchidaEmail author
  • Hiroshi Kawashima
  • Kaori Sato
  • Shinya Takazawa
  • Takahiro Jimbo
  • Tadashi Iwanaka
Case Report


The optimal method of treating long-gap esophageal atresia has not been established; however, the native esophagus is recognized as one of the best materials to use for bridging a long gap. Several case reports describe long-gap esophageal atresia being treated successfully via thoracotomy, by applying external traction sutures to the proximal and distal ends of the esophagus, thereby gradually elongating the esophagus prior to delayed primary anastomosis. However, this method carries a risk of infection and disruption of the esophageal ends. We devised a simple method of internal traction for esophageal elongation, which we performed as a two-step thoracoscopic procedure to treat a neonate with long-gap esophageal atresia.


Long gap Esophageal atresia Thoracoscopy Primary anastomosis Neonate 


Conflict of interest

Yujiro Tanaka and his co-authors have no conflict of interest.


  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    Ein SH, Shandling B, Heiss K. Pure esophageal atresia: outlook in the 1990 s. J Pediatr Surg. 1993;28:1147–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Foker JE, Linden BC, Boyle EM, Jr., Marquardt C. Development of a true primary repair for the full spectrum of esophageal atresia. Ann. Surg. 1997;226:533–41; discussion 41–3.Google Scholar
  4. 4.
    Hunter CJ, Petrosyan M, Connelly ME, Ford HR, Nguyen NX. Repair of long-gap esophageal atresia: gastric conduits may improve outcome—a 20-year single center experience. Pediatr Surg Int. 2009;25:1087–91.CrossRefGoogle Scholar
  5. 5.
    Hadidi AT, Hosie S, Waag KL. Long gap esophageal atresia: lengthening technique and primary anastomosis. J Pediatr Surg. 2007;42:1659–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Rothenberg SS. Thoracoscopic repair of tracheoesophageal fistula in newborns. J Pediatr Surg. 2002;37:869–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Taguchi T. Current progress in neonatal surgery. Surg Today. 2008;38:379–89.CrossRefPubMedGoogle Scholar
  8. 8.
    van der Zee DC, Vieirra-Travassos D, Kramer WL, Tytgat SH. Thoracoscopic elongation of the esophagus in long gap esophageal atresia. J Pediatr Surg. 2007;42:1785–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Stone MM, Fonkalsrud EW, Mahour GH, Weitzman JJ, Takiff H. Esophageal replacement with colon interposition in children. Ann Surg. 1986;203:346–51.CrossRefPubMedGoogle Scholar
  10. 10.
    Kimura K, Soper RT. Multistaged extrathoracic esophageal elongation for long gap esophageal atresia. J Pediatr Surg. 1994;29:566–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Al-Qahtani AR, Yazbeck S, Rosen NG, Youssef S, Mayer SK. Lengthening technique for long gap esophageal atresia and early anastomosis. J Pediatr Surg. 2003;38:737–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Skarsgard ED. Dynamic esophageal lengthening for long gap esophageal atresia: experience with two cases. J Pediatr Surg. 2004;39:1712–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Lopes MF, Reis A, Coutinho S, Pires A. Very long gap esophageal atresia successfully treated by esophageal lengthening using external traction sutures. J Pediatr Surg. 2004;39:1286–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Allal H, Kalfa N, Lopez M, Forgues D, Guibal MP, Raux O, et al. Benefits of the thoracoscopic approach for short- or long-gap esophageal atresia. J Laparoendosc Adv Surg Tech A. 2005;15:673–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Till H, Muensterer OJ, Rolle U, Foker J. Staged esophageal lengthening with internal and subsequent external traction sutures leads to primary repair of an ultralong gap esophageal atresia with upper pouch tracheoesophageal fistula. J Pediatr Surg. 2008;43:E33–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Foker JE, Kendall TC, Catton K, Khan KM. A flexible approach to achieve a true primary repair for all infants with esophageal atresia. Semin Pediatr Surg. 2005;14:8–15.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2012

Authors and Affiliations

  • Yujiro Tanaka
    • 1
  • Hiroo Uchida
    • 1
    Email author
  • Hiroshi Kawashima
    • 2
  • Kaori Sato
    • 1
  • Shinya Takazawa
    • 1
  • Takahiro Jimbo
    • 1
  • Tadashi Iwanaka
    • 2
  1. 1.Department of Pediatric SurgerySaitama Children’s Medical CenterIwatsukiJapan
  2. 2.Department of Pediatric SurgeryUniversity of Tokyo HospitalTokyoJapan

Personalised recommendations