Esophageal Atresia

Abstract

The earliest description of a case of esophageal atresia, associated with the typical form of tracheoesophageal fistula, was presented in 1697 by Tomas Gison in his then popular work „The anatomy of human bodies epitomized“. Already in 1670 William Durston had reported a simple type of esophageal atresia without associated tracheoesophageal fistula in an embryo of a monstertype thoracopagus. In 1861, Hirschsprung was able to publish a remarkable series of 14 cases of the anomaly, including 4 cases which had come under his own notice. Although the anomaly thereafter was well known and described many times, attempts to correct the lesion were sporadic: the first gastrostomy for esophageal atresia was performed by Hoffman in 1898. In 1913 Richter substantially altered the surgical approach to the anomaly by the first transpleural ligation of a tracheoesophageal fistula. The first primary esophageal anastomosis through a right extrapleural approach was done by Langman in 1936. The deformity was uniformly fatal until 1935, when the first child born with atresia without fistula survived thanks to treatment by gastrostomy and many years later by esophageal substitution. In 1939 the first surviving patients having the common type of esophageal atresia with tracheoesophageal fistula were operated upon independently by Leven and Ladd, who used multiple stages in the therapeutic approach (gastrostomy—extrapleural division of the fistula—cervical esophagostomy and much later esophageal substitution).