Long gap esophageal atresia: primary anastomosis after esophageal elongation by bougienage and esophagomyotomy.

Treatment of infants with "long gap" esophageal atresia usually requires a staged procedure consisting of cervical esophagostomy and gastrostomy at birth, and then a bowel interposition between the esophagus and stomach at 1 year of age. Because this approach produces significant morbidity and swallowing dysfunction, an alternative method for treating the long gap atresia is recommended. The upper esophageal pouch can be elongated by preoperative bougienage during a 2 to 10 week period of delay. Intraoperative circumferential esophagomyotomy can further elongate the upper pouch by about 1 cm for each myotomy. Combining these two techniques allows successful primary esophageal reconstruction in infants with long gap esophageal atresia previously considered uncorrectable except by use of colonic or gastric tube interpositions.