Long-gap Esophageal Atresia: Experience with Kato’s Instrumental Anastomosis, with Cervicothoracic Procedure and Primary Anastomosis, and with Retrosternal Colonic Interposition

Abstract

The best esophagus is the esophagus which consists of tissue prepared for its function in the site assigned for it. The way to achieve this in long-gap esophageal atresia was shown by Fritz Rehbein, who developed the thread method and later the olive-thread adaptive technique. Further development led to instrumental insertion of the thread. Kato and Hollmann built a specially designed instrument for this purpose in our experimental laboratory (Kato et al. 1980). The instrument consists of a frame and two hollow bows which can be adjusted so that their tips exactly touch one another (Fig.1). The anesthetized infant is positioned with overstretched head. Then the upper bow is led through the oral cavity to the upper pouch, the lower bow via a gastrostoma to the lower pouch (Fig. 2). When the frame is adjusted it is tested by X-ray to see whether both bows are in exactly opposite positions. Then a strong wire is brought into the lumen of the lower bow, bridging the gap and exiting with a thread attached via the lumen of the upper bow. Bougienage can now be started or, in case of a long gap, stretching dilatation using Rehbein’s olive technique.