Emergency repair of esophageal atresia with lower fistula and segment elongation in cases with a large gap between segments.

Abstract

<h2>Abstract</h2> Esophageal atresia in premature babies with additional severe malformations must be treated by a method which avoids thoracotomy as a primary operation. Two procedures are available to solve this problem: The first is the gastric division as recommended by Randolph¹ in 1968, with transverse section of the stomach, closure of both portions, gastrostomy to prevent reflux of gastric juice into the trachea, and use of the lower gastrostomy for feeding purposes. Esophageal anastomosis can be achieved later. This procedure suffers from the following disadvantages: (1) prolonged intervention; (2) two sutures across the entire diameter of the stomach include the likelihood of suture insufficiency; and (3) reflux of gastric juice into the lung cannot be definitely excluded, not even with high section which again presents technical problems. The second is temporary cardia closure by means of silastic band² with anastomosis of the segments 2 wk later. This method has the following disadvantages: (1) very tight banding may necrose cardia tissue, (2) loose cardia closure could be insufficient and (3) the necessity of relatively strong tension on the band implies only temporary application—limited to a few days.