ESOPHAGEAL ATRESIA TYPES A AND B - UPPER POUCH ELONGATION AND DELAYED ANATOMIC RECONSTRUCTION

Six infants with esophageal atresia without distal fistula, Types A or B; (Gross) or Types II or IIIa (Vogt), have been managed by a planned delay (4 to 10 weeks), followed by direct esophageal anastomosis. During the period prior to definitive surgery, the proximal esophageal segment has been elongated by the daily introduction of a weighted bougie into the upper pouch. The distal esophageal segment has been periodically delineated in order to estimate the length (of separation) of the proximal and distal pouches. In one instance the distal pouch was elongated with a bougie. All infants have been maintained on a high-calorie gastrostomy feeding schedule and continuous proximal esophageal suction. At the time of definitive surgery, the average infant weight was 9 lbs., 1 oz. (4.1 Kg.) One patient required a secondary resection of a stricture at the site of anastomosis 3 years following the original surgery. All patients are at home in a good nutritional state, and taking oral feedings well (3 1 2) years to 3 months following surgery). Early recognition of proximal tracheo-esophageal fistula (Type B) is difficult, and may be made more so by the elongation procedures. Four infants with this anomaly were not accurately diagnosed in the neonatal period. © 1969.