Long-Gap Esophageal Atresia and Thoracoscopic Approach

Long-gap esophageal atresia forms approximately 7% of all esophageal atresia cases. The conventional treatment for long-gap EA-TEF is fistula ligation, diversion, and later esophageal replacement. For esophageal atresia without fistula, diversion and later esophageal replacement are done with stomach or colonic conduit. In either case, the native esophagus is lost, and so are the natural functions of the esophagus. The replacement gut serves as a passive conduit with many long-term complications. Several studies in the past have established the growth potential of upper and lower pouches with the stimulus of traction. With this fact in mind, surgeons have always strived to save the native esophagus in some form or another. In the past five decades with open surgery, many reports of successful elongation of the upper pouch have been documented for various traction techniques. This chapter discusses the concepts of managing long-gap esophageal atresia with and without fistula. Details on the thoracoscopic approach of long-gap atresia are presented with a management algorithm. Thoracoscopy offers a significant advantage in avoiding repeated thoracotomies. A brief review of the literature is also presented for staged management of long-gap atresia conditions.