A staged approach to long gap esophageal atresia employing a XXXX and delayed reconstruction of the esophagus: an experimental study.

@entity825 @entity850 @entity235 @entity254 @entity4649
In @entity235 , the cervical esophagus was divided 5 cm cranial to the thoracic inlet employing a stapler. The distal esophageal stump was attached to the external surface of the @entity825 . A @entity4649 (2 1/2 revolutions) was made in a 3-cm long segment constituting the distal end of the proximal esophageal segment. This was twisted on a bias with the muscle edges approximated by interrupted stitches to cover the denuded submucosal layer. With moderate traction, this segment could be elongated to a length of 5 cm. A subcutaneous tunnel was created in the anterior chest to accommodate the reconstructed proximal esophageal segment (under slight traction), with its distal end forming a cutaneous esophagostomy. A gastrostomy was created using a Gauderer button (Bard Interventional Products, Billerica, MA) for feeding. After 3 weeks, the proximal esophageal segment was mobilized and removed from the subcutaneous tunnel. The distal esophageal segment was freed from the @entity825 and 5 to 8 cm of its proximal end was excised. The proximal (myotomized) esophagus was brought down to the stump of the remaining distal esophagus and an @entity254 formed in an end-to-end fashion. Oral feeding was reestablished within 1 week. Prolonged ingestion, observed soon after operation, gradually improved. During a period of 1 to 6 months after the operation, motility of the myotomized segment was tested by barium swallow and manometry. There was neither diverticulum formation nor @entity850 . Transit of contrast material in the myotomized segment was smooth and rapid. Manometry demonstrated preservation of motility in the myotomized segment of the esophagus.(ABSTRACT TRUNCATED AT 250 WORDS)
