Management of Long-gap Esophagus: Experience with End-to-End Anastomosis Under Maximal Tension

Abstract

During the years 1969–1982, 98 patients with esophageal atresia underwent surgery at our institution. In 15 of the patients a distance of more than 2 cm between the esophageal ends was noted after maximal mobilization of the proximal and distal esophageal segments. Eight of these infants had long-gap atresia with tracheoesophageal fistuale (LGF) to the lower segment. In all these patients end-to-end anastomosis was performed in one layer after closing the tracheoesophageal fistula by the transpleural route, taking great care not to damage the circulation to the lower esophageal segment. A transanastomotic nasogastric tube was left in situ in all patients.