Temporary banding of the gastroesophageal juncture in a very small neonate with esophageal atresia and tracheoesophageal fistula.

A 700 gm, small-for-gestational-age infant with severe respiratory distress, esophageal atresia, and Type C tracheoesophageal fistula was treated with initial banding of the gastroesophageal juncture followed by a gastrostomy. Primary repair was completed later, when the infant had stabilized and grown. Continuous air pressure had distended the fistula, thus dilating the distal esophagus and facilitating repair. In very small, high-risk infants with Type C esophageal atresia and tracheoesophageal fistula, banding of the distal esophagus enables enteral feeding and time for growth while protecting the lungs from repetitive aspiration and pneumonia and facilitates subsequent repair. The patient described here is one of the smallest infants reported to survive this problem. It is also the first time the enlargement of the distal pouch and removal of the band from above have been described.