Long-Gap Esophageal Atresia

  • Pietro Bagolan
  • Francesco Morini


Esophageal atresia is a rare congenital anomaly that occurs in 1 in 4,500 live births. The expected outcome is close to 100% survival, though this varies depending on birth weight, degree of prematurity, and associated anomalies (especially cardiac). Ideal surgical management consists of a primary end-to-end anastomosis between the upper and the lower esophageal remnants and division of a tracheo-esophageal fistula, if one is present. The vast majority can be corrected without difficulty soon after birth. However, this goal is not always easily achievable with all anatomical variants and the management of long-gap esophageal atresia remains a major challenge to the pediatric surgeon. In addition, there is controversy regarding the definition of a “long gap” and a general lack of consensus regarding which is the best technique. This is perhaps due to the fact that attempts to bridge the gap to allow a delayed anastomosis have led to the introduction of several interesting techniques, none of which are perfect.


Primary Anastomosis Esophageal Atresia Esophageal Reconstruction Esophageal Replacement Jejunal Graft 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. Ahmed A, Spitz L. The outcome of colonic replacement of the esophagus in children. Prog Pediatr Surg. 1986;19:37–54.PubMedGoogle Scholar
  2. Anderson KD, Randolph JG. The gastric tube for esophageal replacement in infants and children. J Thorac Cardiovasc Surg. 1973;66:333–42.PubMedGoogle Scholar
  3. Atzori P, Iacobelli BD, Bottero S, et al. Preoperative tracheobronchoscopy in newborns with esophageal atresia: does it matter? J Pediatr Surg. 2006;41:1054–7.CrossRefPubMedGoogle Scholar
  4. Bagolan P, Iacobelli BD, De Angelis P, et al. Long gap esophageal atresia and esophageal replacement: moving toward separation? J Pediatr Surg. 2004;39:1084–90.CrossRefPubMedGoogle Scholar
  5. Bax NMA, van der Zee DC. Jejunal pedicle grafts for reconstruction of the esophagus in children. J Pediatr Surg. 2007;42:363–9.CrossRefPubMedGoogle Scholar
  6. Foker JE, Linden BC, Boyle EM, et al. Development of a true primary repair for the full spectrum of esophageal atresia. Ann Surg. 1997;226:533–43.CrossRefPubMedGoogle Scholar
  7. Puri P, Blake K, O’Donnell B, et al. Delayed primary esophageal anastomosis following spontaneous growth of esophageal segments in esophageal atresia. J Pediatr Surg. 1981;16:180–3.CrossRefPubMedGoogle Scholar
  8. Puri P, Khurana S. Delayed primary esophageal anastomosis for pure esophageal atresia. Semin Pediatr Surg. 1998;7:126–9.PubMedGoogle Scholar
  9. Ring WS, Varco RL, L’Heureux PR, et al. Esophageal replacement with jejunum in children: an 18 to 33 year follow-up. J Thorac Cardiovasc Surg. 1982;83:918–27.PubMedGoogle Scholar
  10. Spitz L, Kiely E, Sparon T. Gastric transposition for esophageal replacement in children. Ann Surg. 1987;206:69–73.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Medical and Surgical NeonatalologyBambino GESU Children’s HospitalRomaItalia

Personalised recommendations