THE COMPLEX NATURE OF TYPE-A (LONG-GAP) ESOPHAGEAL ATRESIA

Background. The management of neonates with long-gap esophageal atresi a without a fistula (type A) is complex. Options for esophageal recons truction include use of the native esophagus or replacement with colon , stomach, or small bowel. The purpose of this study was to evaluate t he long-term outcome of children variously treated with this defect. M ethods. The course of 23 infants with type A esophageal atresia were r etrospectively reviewed. Diagnosis was achieved by plain radiographs a nd endoscopy. The mean gestational age was 33.9 weeks, and the birth w eight was 1.87 kilograms. Results. Two of nine infants with serious as sociated defects died early, and one infant with brain damage was not reconstructed. Initial treatment consisted of gastrostomy and proximal pouch suction (n = 10) or cervical esophagostomy (n = 10) Reconstruct ive procedures were performed in 20 infants, including colon interposi tion in eight infants, reversed gastric tube in two infants, and delay ed primary esophageal repair (often with myotomy) in 10 infants. Secon dary procedures were required for three infants with failed colons, on e infant with a Sailed gastric tube, and one infant with a native esop hageal disruption. Long-term satisfaction was 90% with esophagus, 63% with colon, and 50% with stomach. Conclusions. When possible, native e sophageal reconstruction is the procedure of choice rather than esopha geal replacement.