Esophageal replacement by gastric tube: is three-stage surgery justified?

Abstract

Background Long gap esophageal atresia with or without  tracheoesophageal fistula is a challenging problem. We present our  experience with the three-stage surgery technique.

Materials and methods All patients with long gap esophageal atresia were operated by gastric tube esophagostomy in the second stage and esophagostomy closure in the third stage. The patients were then  evaluated for intraoperative and postoperative complications, need for a ventilator, and follow-up.

Results There were a total of eight patients. There were no intraoperative complications. There was no anastomotic leak in any patient. One patient died in the postoperative period because of respiratory distress.  Follow-up of the remaining patients was satisfactory.

Conclusion Three-stage surgery may avoid respiratory complications  because of the short operative time and less intervention. Anastomotic leak and stenosis in the long esophageal suture line may also be avoided. This may be a useful alternative under a resource-limited condition, with optimal outcome. 

Keywords: esophageal replacement, gastric tube, long gap esophageal atresia, pure esophageal atresia