Efficacy of delayed internal traction for long gap esophageal atresia

Abstract

Objective Optimal treatment of long gap esophageal atresia (LGEA) is demanding in neonatal surgery. Consensus dictates conserving autologous esophagus for reconstructing esophagus in LGEA patients. Internal traction by stress bouige for elongation was achieved by utilizing native esophagus for esophageal continuity. Methods From January 2015 to December 2015, 5 neonatal cases with LGEA were recruited. The clinical types were I (n=4) and Ⅲa (n=1). Internal traction was performed after comprehensive evaluations. After inserting a bougie into upper and lower esophageal pouches through oral cavity, gastrostomy was performed with appropriate longitudinal force for increasing esophageal length. The gap length was evaluated regularly by esophagram. All of them were fed by gastrostomy for maintaining a proper nutritional status and continuous suction in upper pouch was applied for avoiding aspiration pneumonia during traction. Results The initial gap length ranged from 5 to 7.5 vertebral bodies. After internal traction, gap distance was decreased to 0 to 2.5 vertebral bodies. The duration of elongation process starting from initial stretching until anastomosis varied from 6 to 14 weeks. Finally, the anastomosis was performed successfully. The specific procedures were end-to-end anastomosis (n=1), flip-flap (n=1) and Livaditis (n=3). Such postoperative complications as leak of anastomosis and overt gastroesophageal reflux disappeared. Three cases of anastomotic stricture improved greatly after 3-7 sessions of balloon dilations. Resuming full oral intake without vomiting or other feeding difficulties, all of them had the same patterns of growth and development as normal same-age counterparts. There was no need for special feeding. Conclusions Delayed internal traction is effective for elongating esophageal segments during primary anastomosis for LGEA. Key words: Esophageal atresia; Traction; Esophagogastrostomy