Management of long-gap esophagus: experience with end-to-end anastomosis under maximal tension.

From 1969 to 1982, 15 cases of long-gap esophageal atresia were treated. Twelve patients could be managed by direct end-to-end anastomosis - ten primary and two delayed. Anastomotic leakage was noted in all patients, causing anastomotic obstruction in nine, which had to be treated with repeated esophageal dilatations. In one patient the esophageal dilatation resulted in esophageal perforation, with a fatal outcome. The remaining 11 patients are all doing well. Three patients were subjected to colonic transposition, two primary and one delayed according to Waterston. One of these subjected to primary colonic transposition died postoperatively from cerebral hemorrhage. The other one is now doing well after resection of the transposed colonic segment which fibrotized but could be resected, after which the esophageal ends could be anastomosed. The patient subjected to delayed colon transposition is also free of major swallowing problems following immediate postoperative anastomotic stricture which could be managed by repeated dilatations.