A practical approach to the investigation and management of long gap oesophageal atresia.

Oesophageal atresia in which there is a long gap between the ends of the oesophagus remains one of the most difficult problems confronting the pediatric surgeon. While it is generally accepted that the best results are obtained if oesophageal continuity is established, this may be difficult to achieve. Various manoeuvres have been advocated to mobilise and lengthen the oesophagus, and if these measures fail, cervical oesophagostomy and oesophageal replacement may become necessary. This paper outlines the situations in which long gap oesophageal atresia might be expected, how infants should be investigated to determine the most appropriate type and time of procedure, and provides a basis for surgical decision-making during the operative procedure itself. These guidelines should enable oesophageal continuity to be obtained in the vast majority of infants with long gap oesophageal atresia.