Long Gap Esophageal Atresia

Abstract

Long gap esophageal atresia (LGEA) presents a unique challenge for a surgeon attempting repair. Although no uniform anatomic definition exists, LGEA can be defined as any distance between the atretic ends of the esophagus that is too wide to allow for primary anastomosis. The goals of reconstruction are to safely establish a patent conduit between the ends of the esophagus and to ensure the greatest degree of long-term functionality, without a prolonged hospitalization and significant delay before oral feeding. It is generally believed that the native esophagus is the best conduit. Thus, many strategies have been developed over the years to preserve the native esophagus which include delayed primary repair and various lengthening techniques. Unfortunately, the concept of “preserving the native esophagus at all cost” is not without associated mortality and morbidity. Many patients require prolonged hospitalization, while others may experience leak, stricture, and/or dysmotility. Despite maximal effort, preserving the native esophagus is sometimes not possible. In these cases, esophageal replacement is the only alternative option.