Experiences of treating long-gap esophageal atresia

Objective To explore the short-term and long-term postoperative outcomes and formulate individualized treatments for long-gap esophageal atresia （LEA）after birth.Methods From January 2003 to June 2013,29 LEA patients were admitted into our hospital.There were 20 boys and 9 girls.The types were isolated esophageal atresia （type Ⅰ,n=1 0 ）and esophageal atresia with trachea-esophageal fistula （type Ⅲa,n=19）.For type I patients,gastric tube esophagoplasty,gastric transposition,esophageal flap esophagoplasty and end-to-end esophageal anastomosis were performed respectively.For type Ⅲ a patients, esophageal replacement with colon, circular myotomy for esophagus lengthening and end-to-end esophageal anastomosis.Results Twenty-seven cases survived and two died.The postoperative complications were pneumonia （n=13）,anastomotic leakage （n=7）, stenosis （n=9）,pneumothorax （n=1）,chest infection （n=5）and digestive bleeding cause by stress ulceration （n=1 ）.The gastro-esophageal reflux was found by contrast study before discharge in 7 cases.The overall follow-up period was 2 months to 10 years and 14 cases for over 1 year.And 12 cases vomited within 3 months and improved obviously later.Chest distress occurred in 4 cases during rapid ingestions. Gastric tube esophagoplasty （n= 2 ） and gastric transposition （n= 2 ） were performed.Gastric-esophageal reflux was found in 9 cases by contrast study.Among 7 cases of 24-hour esophageal pH monitoring,reflux appeared at midnight in 4 cases and underwent no anti-reflux operation.Conclusions For esophageal replacement,autologous esophagus has the best functions. Eesophageal replacement with colon is an effective treatment for cervical esophagostomy and gastrostomy.And gastric tube esophagoplasty and gastric transposition may be used discreetly in neonates with LEA. Key words: Esophageal atresia Neonate Treatment protocols