[Long segment esophageal atresia and possibilities of esophageal replacement]

Abstract

In up to 20% of newborns with esophageal atresia a primary anastomosis of the esophagus is not possible because of the long distance between the two ends. In some cases a circular myotomy can elongate the upper pouch to allow a primary anastomosis. If primary anastomosis is not possible bougienage of the upper and lower pouch may stimulate growth of the esophagus and allow direct anastomosis after several weeks. In all other cases esophageal replacement is necessary. Colonic replacement of the esophagus must be weighed against replacement by jejunum, gastric interposition and the gastric tube. Each technique for esophageal replacement involves characteristic complications, and these are discussed in detail. For about 80% of the patients esophageal replacement allows a normal life with normal oral uptake of nutrition.