ESOPHAGEAL RECONSTRUCTION BY ELONGATION OF THE LESSER GASTRIC CURVATURE

Long-gap esophageal atresias (EA) generally require surgical substitut ion using colon, jejunum, or a portion of the stomach. In these proced ures, as in total gastric pull-up operations, the distal portion of th e esophagus is sacrificed. Experimental studies on cadaver stomachs ha ve shown that retrosternal transfer of the distal esophagus with prese rvation of all esophageal portions is possible when the lesser curvatu re is incised diagonally, provided the collateral circulation via the left gastric artery (LGA) is preserved. A tension-free esophageal anas tomosis is then carried out intrathoracically or cervically. This tech nique was employed successfully in eight children. In two cases ligati on of the LGA alone was sufficient; in six an additional incision in t he lesser curvature was required to achieve adequate length. This proc edure is advantageous in that all portions of the esophagus are preser ved and, due to the retrosternal position, a thoracotomy is unnecessar y. The morbidity is significantly lower than that associated with all the other substitution techniques. The main complications included cer vical anastomotic leaks, which closed spontaneously, and stenoses that required bouginage. There was no mortality. From our experience to da te, it can be concluded that esophageal anastomosis is possible in lon g-gap EA after incising the lesser gastric curvature, and that substit ution plasties can be avoided.