One-stage esophagus replacement in neonates to treat long gap esophageal atresia

Objective The treatment of long gap esophageal atresia( LEA) is always a challenge in neonatal surgery.10 patients of LEA who were operated on using one-stage esophageal replacement from March 2006 to June 2011were analyzed.Methods 10 cases of LEA were operated in the study period,including 8 cases of pure EA and 2 cases of Ⅲa EA.They were 6 male and 4 female babies.Associate anomalies were found in most of them.Definitive surgery was performed in 9 cases,with 4 gastric tubes and 5 gastric transpositions.Gastrostomy was done in one preterm case with low birth weight and end-to-end esophageal anastomosis was successful after 8 weeks following spontaneous growth of esophageal segments.Jejunal feeding tube was routinely inserted during the surgery and baby milk was injected on second day after operation.Results All cases were followed up for between 2 months to 5 years.Nine cases survived and one died because of parents abandoning treatment.The early complications included pneumonia in 5 cases,anastomotic leaks in 3 cases and anastomotic stricture in 3 cases.They were cured by conservative treatment and the stricture was treated by balloon dilation for 1-2 times.Recurrence pneumothorax occurred in one case which was managed by drainage.No gastroesophageal reflux was detected using contrast study.6 cases had further 24-hour esophageal pH monitoring.Gastroesophageal reflux was found in 2 cases but no anti-reflux procedure was needed.Conclusions Ohe-stage esophagus replacement in neonates to treat LEA is feasible and acceptable clinically and the outcome is good if these patients are managed by specialist team. Key words: Esophageal atresia;  Esophagus replacement ;  Neonate