A practical approach to the investigation and management of long gap oesophageal atresia.

Oesophageal atresia in which there is a long gap between the ends of the oesophagus remains one of the most difficult problems confronting the pediatric surgeon. While it is generally accepted that the best results are obtained if oesophageal continuity is established, this may be difficult to achieve. Various manoeuvres have been advocated to mobilise and lengthen the oesophagus, and if these measures fail, cervical oesophagostomy and oesophageal replacement may become necessary. This paper outlines the situations in which long gap oesophageal atresia might be expected, how infants should be investigated to determine the most appropriate type and time of procedure, and provides a basis for surgical decision-making during the operative procedure itself. These guidelines should enable oesophageal continuity to be obtained in the vast majority of infants with long gap oesophageal atresia.

Transhiatal gastric transposition of a long gap esophageal atresia

Transhiatal gastric transposition was performed in a long gap esophageal atresia without tracheoesophageal fistula. The patient was a 12 months old female infant with previous stamm-type gastrostomy. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal blind pouches of esophagus were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up into the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was safely performed in the neck. There were neither anastomotic leak nor early anastomotic stricture. The oral feeding was quickly established. There was no clinical evidence of regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. The low morbidity combined with satisfactory functional result indicates that the transhiatal gastric transposition is a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.