Skip to Main Content

++

This chapter presents the most common congenital malformations of the esophagus that require surgical correction in infants and children. Today, most of these entities can be corrected, and a child can lead a normal life after surgery. That was not true until 1939, when Logan Leven of Minneapolis1 and William E. Ladd of Boston2 independently saved a newborn with esophageal atresia on the same date! The operation consisted of dividing the tracheoesophageal fistula (TEF), marsupializing the blindly ending upper esophageal pouch, and feeding the baby temporarily through a gastrostomy. Later, a multistaged reconstruction was performed to make an antethoracic esophageal substitute, which was placed subcutaneously anterior to the sternum. The lower two-thirds of this conduit consisted of a Roux-en-Y loop of upper jejunum that bypassed the stomach and duodenum. The upper third of the conduit was a tubularized full-thickness graft comprised of skin and subcutaneous tissue. This was used to bridge the gap between the upper esophageal segment, which had been marsupialized in the neck, and the Roux-en-Y loop, which was brought up to the level of the upper sternum.

++

An important milestone in surgery for esophageal atresia was an insightful paper by Dr. Thomas Lanman, a colleague of Ladd, in 1940 describing a series of 32 esophageal atresia failures at Children's Hospital Boston.3 Lanman predicted, “Given a suitable case in which the patient is seen early, I feel that with greater experience, improved technique, and good luck, the successful outcome of a direct anastomosis can and will be reported in the near future.” This type of staged repair was abandoned in 1943 when Dr. Cameron Haight of Ann Arbor, Michigan, was first to report the primary definitive repair of esophageal atresia and TEF in the neonate.4 This was an important step in thoracic surgery for infants and children. Surgical treatments for other congenital esophageal anomalies were developed subsequently and are also described in this chapter.

++

The spectrum of pathology in infants with esophageal atresia, with or without TEF, is illustrated in Fig. 38-1. These include esophageal atresia with distal TEF, without TEF, with proximal TEF, and with double (proximal and distal) TEF. Isolated TEF without esophageal atresia, so-called H-fistula, which usually occurs in the neck rather than midmediastinum, is also encountered. In most infants, esophageal atresia occurs with a single TEF. This form is observed in approximately 85% of affected infants. The upper esophageal pouch ends blindly, and there is a gap between it and the lower esophageal segment. The fistula from the lower esophageal segment usually enters the trachea just above its bifurcation. The blind upper pouch actually may overlap the nearby lower esophageal segment, or the two ends may be separated by a centimeter or more. Esophageal atresia without TEF is the next most common form and is seen in approximately 8% of infants.

++

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.