We describe our experience using a modified suture fistula technique for addressing tension in longer gap esophageal atresia (EA). Esophagoesophagopexy (EEP) is the tacking of the proximal and distal ends of esophageal pouches without formal anastomosis. In this retrospective cohort, we review the outcomes of patients with EA after EEP.
We reviewed the operative reports of EA cases treated at our institution from 1997 to 2016 and identified all patients described as having EEP.
Of 129 EA cases, five patients underwent EEP. Formal anastomosis was not done due to patient’s instability, prematurity, or long gap. Median birth weight was 1.4 kg (0.6–2.2 kg), and median gestational age at birth was 29 weeks (25–34 weeks). Age at time of EEP ranged 0–5 months. Esophagoesophageal fistula was confirmed in three patients. All three had strictures requiring weekly dilations. One of these patients died. The two surviving patients underwent fundoplication.
We describe an alternative technique for esophageal anastomosis in patients for whom a standard anastomosis is not possible. EEP can lead to a functional anastomosis through fistulization and avoid the morbidity of multiple thoracotomies and lengthening procedures. Families should be educated on the potential need for dilations and antireflux procedures.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Foker JE, Linden BC, Boyle EM Jr et al (1997) Development of a true primary repair for the full spectrum of esophageal atresia. Ann Surg 226:533–543
Schullinger JN, Vinocur CD, Santulli TV (1982) The suture fistula technique in the repair of selected cases of esophageal atresia. J Pediatr Surg 17:234–236
Brown S, Nixon HH (1983) Spontaneous anastomosis of the esophagus in esophageal atresia. J Pediatr Surg 18:293–295
Kimura K, Nishijima E, Tsugawa C et al (1987) A new approach for the salvage of unsuccessful esophageal atresia repair: a spiral myotomy and delayed definitive operation. J Pediatr Surg 22:981–983
Kimura K, Soper RT (1994) Multistaged extrathoracic esophageal elongation for long gap esophageal atresia. J Pediatr Surg 29:566–568
Kimura K, Nishijima E, Tsugawa C et al (2001) Multistaged extrathoracic esophageal elongation procedure for long gap esophageal atresia: experience with 12 patients. J Pediatr Surg 36:1725–1727
Al-Qahtani AR, Yazbeck S, Rosen NG et al (2003) Lengthening technique for long gap esophageal atresia and early anastomosis. J Pediatr Surg 38:737–739
Shafer AD, David TE (1974) Suture fistula as a means of connecting upper and lower segments in esophageal atresia. J Pediatr Surg 9:669–673
Marshall DG (1987) An alternative to an interposition procedure in esophageal atresia. J Pediatr Surg 22:775–778
Stringel G, Lawrence C, McBride W (2010) Repair of long gap esophageal atresia without anastomosis. J Pediatr Surg 45:872–875
Tovar JA, Fragoso AC (2011) Current controversies in the surgical treatment of esophageal atresia. Scand J Surg 100(4):273–278
Mahour GH, Woolley MM, Gwinn JL (1974) Elongation of the upper pouch and delayed anatomic reconstruction in esophageal atresia. J Pediatr Surg 9:373–383
Hendren WH, Hale JR (1975) Electromagnetic bougienage to lengthen esophageal segments in congenital esophageal atresia. N Engl J Med 293:428–432
Zaritzky M, Ben R, Zylberg GI, Yampolsky B (2009) Magnetic compression anastomosis as a nonsurgical treatment for esophageal atresia. Pediatr Radiol 39:945–949
Karabulut R, Turkyilmaz Z, Sonmez K, Ozbayoglu A, Basaklar AC (2014) An approximation technique for primary anastomosis (Gazi Method) in selected cases of long gap esophageal atresia. Prensa Med Argent 100(1):1–3
Gallo G, Zwaveling S, Groen H, Van der Zee D, Hulscher J (2012) Long-gap esophageal atresia: a meta-analysis of jejunal interposition, colon interposition, and gastric pull-up. Eur J Pediatr Surg 22(6):420–425
Livaditis A, Radberg L, Odensjo G (1972) Esophageal end-to-end anastomosis. Reduction of anastomotic tension by circular myotomy. Scand J Thorac Cardiovasc Surg 6:206–214
Jaureguizar E, Vazquez J, Murcia J et al (1985) Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fistula. J Pediatr Surg 20:511–514
Freeman NV, Walkden J (1969) Previously unreported shoulder deformity following right lateral thoracotomy for esophageal atresia. J Pediatr Surg 4:627–636
Durning RP, Scoles PV, Fox OD (1980) Scoliosis after thoracotomy in tracheoesophageal fistula patients. J Bone Joint Surg Am 62:1156–1158
Cherup LL, Siewers RD, Futrell JW (1986) Breast and pectoral muscle maldevelopment after anterolateral and posterolateral thoracotomies in children. Ann Thorac Surg 41:492–497
Westfelt JN, Nordwall A (1991) Thoracotomy and scoliosis. Spine 16:1124–1125
Chetcuti P, Myers NA, Phelan PD et al (1989) Chest wall deformity in patients with repaired esophageal atresia. J Pediatr Surg 24:244–247
Gauderer MW (2003) Delayed blind-pouch apposition, guide wire placement, and nonoperative establishment of luminal continuity in a child with long gap esophageal atresia. J Pediatr Surg 38:906–909
Foker JE, Krosch TCK et al (2009) Long-gap esophageal atresia treated by growth induction: the biological potential and early follow-up results. Semin Pediatr Surg 18:23–29
Mochizuki K, Shinkai M, Take H et al (2012) A modified Foker’s technique for long gap esophageal atresia. Pediatr Surg Int 28:851–854
Van der Zee DC (2011) Thoracoscopic elongation of the esophagus in long gap esophageal atresia. J Pediatr Gastroenterol Nutr 52:S13-S15
Van der Zee DC, Gallo G, Tytgat SHA (2015) Thoracoscopic traction technique in long gap esophageal atresia: entering a new era. Surg Endosc 29:3324–3330
Wanaguru D, Langusch C, Krishnan U, Variavandi V, Jiwane A, Adams S, Henry G (2017) Is fundoplication required after the Foker procedure for long gap esophageal atresia? J Pediatr Surg 52(7):1117–1120
Garritano S, Irino T, Scandavini CM, Tsekrekos A, Lundell L, Rouvelas I (2017) Long-term functional outcomes after replacement of the esophagus in pediatric patients: a systematic literature review. J Pediatr Surg 52(9):1398–1408
Cimador M, Carta M, Di Pace MR, Natalè G, Castiglione A, Sergio M, Corsello G, De Grazia E (2006 Feb) Primary repair in esophageal atresia. The results of long term follow-up. Minerva Pediatr 58(1):9–13
Tomaselli V, Volpi ML, Dell’Agnola CA, Bini M, Rossi A, Indriolo A (2003) Long-term evaluation of esophageal function in patients treated at birth for esophageal atresia. Pediatr Surg Int 19(1–2):40–43 (Epub 2002 Nov 14)
Lal DR, Gadepalli SK, Downard CD, Ostlie DJ, Minneci PC, Swedler RM, Chelius T, Cassidy L, Rapp CT, Deans KJ, Fallat ME, Finnell SME, Helmrath MA, Hirschl RB, Kabre RS, Leys CM, Mak G, Raque J, Rescorla FJ, Saito JM, St Peter SD, von Allmen D, Warner BW, Sato TT, Midwest Pediatric Surgery Consortium (2017) Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 52(8):1245–1251
This work was supported by the National Institutes of Health [5T32DK007573-27].
About this article
Cite this article
Chumfong, I., Lee, H., Padilla, B.E. et al. Esophagoesophagopexy technique for assisted fistulization of esophageal atresia. Pediatr Surg Int 34, 63–69 (2018). https://doi.org/10.1007/s00383-017-4164-6
- Esophageal atresia
- Long gap esophageal atresia
- Esophageal anastomosis
- Suture fistula