The complex nature of type A (long-gap) esophageal atresia

Frederick Rescorla, K. W. West, L. R. Scherer, J. L. Grosfeld, K. Kimura, J. Z. Jona, D. R. King

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background. The management of neonates with long-gap esophageal atresia without a fistula (type A) is complex. Options for esophageal reconstruction include use of the native esophagus or replacement with colon, stomach, or small bowel. The purpose of this study was to evaluate the long-term outcome of children variously treated with this defect. Methods. The course of 23 infants with type A esophageal atresia were retrospectively reviewed. Diagnosis was achieved by plain radiographs and endoscopy. The mean gestational age was 33.9 weeks, and the birth weight was 1.87 kilograms. Results. Two of nine infants with serious associated 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). Reconstructive procedures were performed in 20 infants, including colon interposition in eight infants, reversed gastric tube in two infants, and delayed primary esophageal repair (often with myotomy) in 10 infants. Secondary procedures were required for three infants with failed colons, one infant with a failed gastric tube, and one infant with a native esophageal disruption. Long-term satisfaction was 90% with esophagus, 63% with colon, and 50% with stomach. Conclusions. When possible, native esophageal reconstruction is the procedure of choice rather than esophageal replacement.

Original languageEnglish
Pages (from-to)658-664
Number of pages7
JournalSurgery
Volume116
Issue number4
StatePublished - 1994

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Esophageal Atresia
Stomach
Colon
Esophagus
Esophagostomy
Gastrostomy
Suction
Birth Weight
Endoscopy
Gestational Age
Fistula
Newborn Infant

ASJC Scopus subject areas

  • Surgery

Cite this

Rescorla, F., West, K. W., Scherer, L. R., Grosfeld, J. L., Kimura, K., Jona, J. Z., & King, D. R. (1994). The complex nature of type A (long-gap) esophageal atresia. Surgery, 116(4), 658-664.

The complex nature of type A (long-gap) esophageal atresia. / Rescorla, Frederick; West, K. W.; Scherer, L. R.; Grosfeld, J. L.; Kimura, K.; Jona, J. Z.; King, D. R.

In: Surgery, Vol. 116, No. 4, 1994, p. 658-664.

Research output: Contribution to journalArticle

Rescorla, F, West, KW, Scherer, LR, Grosfeld, JL, Kimura, K, Jona, JZ & King, DR 1994, 'The complex nature of type A (long-gap) esophageal atresia', Surgery, vol. 116, no. 4, pp. 658-664.
Rescorla F, West KW, Scherer LR, Grosfeld JL, Kimura K, Jona JZ et al. The complex nature of type A (long-gap) esophageal atresia. Surgery. 1994;116(4):658-664.
Rescorla, Frederick ; West, K. W. ; Scherer, L. R. ; Grosfeld, J. L. ; Kimura, K. ; Jona, J. Z. ; King, D. R. / The complex nature of type A (long-gap) esophageal atresia. In: Surgery. 1994 ; Vol. 116, No. 4. pp. 658-664.
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AU - Jona, J. Z.

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N2 - Background. The management of neonates with long-gap esophageal atresia without a fistula (type A) is complex. Options for esophageal reconstruction include use of the native esophagus or replacement with colon, stomach, or small bowel. The purpose of this study was to evaluate the long-term outcome of children variously treated with this defect. Methods. The course of 23 infants with type A esophageal atresia were retrospectively reviewed. Diagnosis was achieved by plain radiographs and endoscopy. The mean gestational age was 33.9 weeks, and the birth weight was 1.87 kilograms. Results. Two of nine infants with serious associated 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). Reconstructive procedures were performed in 20 infants, including colon interposition in eight infants, reversed gastric tube in two infants, and delayed primary esophageal repair (often with myotomy) in 10 infants. Secondary procedures were required for three infants with failed colons, one infant with a failed gastric tube, and one infant with a native esophageal disruption. Long-term satisfaction was 90% with esophagus, 63% with colon, and 50% with stomach. Conclusions. When possible, native esophageal reconstruction is the procedure of choice rather than esophageal replacement.

AB - Background. The management of neonates with long-gap esophageal atresia without a fistula (type A) is complex. Options for esophageal reconstruction include use of the native esophagus or replacement with colon, stomach, or small bowel. The purpose of this study was to evaluate the long-term outcome of children variously treated with this defect. Methods. The course of 23 infants with type A esophageal atresia were retrospectively reviewed. Diagnosis was achieved by plain radiographs and endoscopy. The mean gestational age was 33.9 weeks, and the birth weight was 1.87 kilograms. Results. Two of nine infants with serious associated 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). Reconstructive procedures were performed in 20 infants, including colon interposition in eight infants, reversed gastric tube in two infants, and delayed primary esophageal repair (often with myotomy) in 10 infants. Secondary procedures were required for three infants with failed colons, one infant with a failed gastric tube, and one infant with a native esophageal disruption. Long-term satisfaction was 90% with esophagus, 63% with colon, and 50% with stomach. Conclusions. When possible, native esophageal reconstruction is the procedure of choice rather than esophageal replacement.

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