Multistaged extrathoracic esophageal elongation for long gap esophageal atresia.

The authors developed an extrathoracic multistaged esophageal elongation scheme for managing patients with long gap esophageal atresia. The protocol consists of (1) initial cutaneous esophagostomy of the proximal esophagus and feeding gastrostomy followed by (2) multistaged extrathoracic elongations of the proximal esophagus, translocating its cutaneous stoma down the anterior chest wall at intervals of several weeks, and (3) esophageal end-to-end anastomosis in the mediastinum. These procedures were successfully employed in an infant with esophageal atresia with an initial gap of seven vertebral bodies. Three elongation procedures, including the initial one, were performed at intervals of 2 to 6 months, which allowed a tension-free esophageal anastomosis in the mediastinum. Since the initial operation, the patient has been sham-fed with formula, which was collected in a stomal bag and refed via the gastrostomy. Immediately after the final operation, no difficulty was experienced in nipple feeding. She has had follow-up for 3 years, and the result is satisfactory.