Clinical experiences of delayed primary anastomosis for type I congenital esophageal atresia

Objective To summarize our experiences of delayed primary anastomosis for type Ⅰcongenital esophageal atresia.Methods A retrospective review was performed for 7 patients with typeⅠ congenital esophageal atresia.There were 5 females and 2 males with a birth weight of 2.170 to 2. 615 kilograms.All had a prenatal diagnosis of hydramnios.And esophageal atresia was suspected in 5 cases by ultrasonic examinations.There were congenital heart disease （n=4）and congenital anal-recta malformation （n=2）.Gastrostomy was performed after birth and the gap between proximal and distal esophagus measured radiologically. Second surgery was performed by end-to-end esophageal anastomosis at weeks 8-16.The correlation was analyzed between the growth body weight and the growth of blind esophagus during delayed operation period.The intra-operative blind end distance was observed and different operative approaches were selected. Then follow-ups were conducted for postoperative complications,long-term growth and development,including feedings.Results During 8-16 weeks,7 cases grew well with an average growth weight of 2.98 kg.The esophageal growth of two blind sides was 1-2.5 cm.Esophageal growth length and weight gain had no significant correlation （R=0.171,P=0.713）.And there was no obvious correlation with two surgical intervals （R=0. 084,P=0.084）.During second surgery,after a full separation of two blind esophageal sides,the gap was 〈1.0 cm and end-to-end esophageal anastomosis was completed （n=3）;1.5-2.0 cm,internal traction after 5-7 days （n=3）;3 cm,external traction at Day 7.Internal and external tractions were applied for post-operative anastomotic leakage and healed by drainage （n=4 ）.Seven cases were followed up for 14-66 months.Five cases of postoperative anastomotic stricture underwent dilation under gastroscopy.Among 4 cases of gastro-esophageal reflux,2 underwent anti-reflux surgery at the age of one year and their growth and weight returned to normal and could eat solid food.Conclusions Delayed esophageal anastomosis for type I esophageal atresia can achieve the purpose of using their own esophagus;Internal and external tractions induce rapid short-term esophageal growth.And more postoperative complications occur for type I esophageal atresia. Key words: Esophageal atresia Delayed primary anastomosis