Esophageal Atresia and Tracheoesophageal Fistula: Purpose

Figure 7:
An esophagram taken after a true primary
repair of an ultra long gap EA. The
esophageal repair is intact and shows a
virtually normal appearing esophagus. This
patient was born with an ultra long gap pure
EA. A period of external traction was
needed until the ends grew enough so that
Treatment
http://eatef.umn.edu/treatment.html[12/8/2021 5:36:12 PM]
they could be brought together. After
several dilations, the esophagus now looks
relatively normal and occupies its normal
position within the chest. At the bottom of

1. Foker, J.E. and Boyle, E.M.: Esophageal atresia and
tracheoesophageal fistula. In: Pearson, F.G., Deslauriers, J.,
Ginsberg, R.J., Hiebert, C.A., McKneally, M.F. and Urschel, Jr.,
H.C. (eds), Esophageal Surgery. New York, NY, Churchill
Linvingstone Inc., 1995, pp. 151-183.
2. Spitz, Lewis: Esophageal Atresia: Past, Present, and Future.
Journal of Pediatric Surgery. 1:2:19-25, 1996.
3. Boyle, E.M., Irwin, E.D., Foker, J.E.: Primary repair of ultra long gap
esophageal atresia: results without a lengthening procedure. Ann.

a. Overall goals
Our late results, so far, have been excellent. All children, even those who
began with the longest gaps or had failed previous operations, have had
a successful true primary repair. Those who are far enough out from the
repair (usually a year), to allow complete resolution of anastomotic
strictures and to have overcome oral aversion, are eating normally. One
child came to us with a tracheostomy in place and although he now has a
very satisfactory esophagus, he will not learn to eat until the

Again, the goals are quite simple. The child should be able to eat
normally and as they wish. There should be no need for a g-tube for
supplemental feedings or for medications.
So far, we have met our goals. All of the children (about 90 cases) have
had a true primary repair. No interposition grafts have been done since
1983. Only the most recently repaired infants have not converted
completely to normal diets and still have their g-tubes. They are on track,
however, and should accomplish this soon.

Figure 6:

Figure 5:

The basic operation

Figure 4:

Another gapogram with even a shorter esophageal segments. In this case, the intrathoracic (chest portion) esophagus is entirely missing.

Figure 3: