Abstract
Between 1980 and 1993, 62 cases of esophageal atresia were treated by the authors with a survival rate of 81%. Of the 17 Waterston A patients, primary anastomosis was done in 12 cases. A simultaneous gastrostomy was performed in the first 2. Of the 15 Waterston B1 and C1 patients, 14 were treated primary anastomosis without gastronomy. Of the 30 Waterston B2 and C2 patients, a preliminary gastrostomy was done in 11 cases for severe pneumonitis or long-gap atresia. The remaining 19 cases were treated by primary anastomosis without gastrostomy. Among the 45 patients treated by primary anastomosis (2 with and 43 without a gastrostomy), there were 6 mortalities, with pneumonia being the cause of death in only 1. We conclude that gastrostomy is contraindicated when primary anastomosis is feasible; primary anastomosis can be done safely in low-birth-weight infants; and the preoperative pulmonary condition can frequently be improved without a decompression gastrostomy
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