Long-gap Esophageal Atresia: Prenatal Diagnosis of by D. Booss, J. Kotlarski (auth.), Primarius Professor Dr.

By D. Booss, J. Kotlarski (auth.), Primarius Professor Dr. Peter Wurnig (eds.)

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Additional resources for Long-gap Esophageal Atresia: Prenatal Diagnosis of Congenital Malformations

Example text

Age distribution of patients according to diagnosis at the time of colonic interposition 40 A. Ahmed and L. Spitz years of life; these included two infants undergoing primary colonic interposition without preliminary cervical esophagostomy before 2 months of age. Colonic replacement for esophageal stricture was never performed during the first year of life, the cases being evenly distributed between 1 and 14 years of age. Previous Surgery Of the 92 patients with esophageal atresia, 90 had previously undergone a left cervical esophagostomy and a feeding gastrostomy.

The use of a colonic segment has become the most widely accepted method of total or partial replacement of the esophagus in children. The colon has proven to be relatively acid resistant, and significant ulceration in the interposed colon is unusual. Many operations have been devised for placing various segments of the colon intrapleurally (Sandblom 1948; Waterston 1969), retrosternally (Javid 1954; Dale and Sherman 1955; Gross and Firestone 1967; Schiller et al. 1971), subcutaneously (Lundblad 1921), and in the normal esophageal route in the posterior mediastinum (Belsey 1965; Akiyama et al.

A partial intrathoracic replacement was employed in 18 children, with the proximal anastomosis within the left thoracic cavity and the distal anastomosis to the distal esophageal stump in two cases and to the stomach in 16. The remaining ten procedures consisted of a retrosternal placement of the colonic interposition. Two colon loops had to be abandoned prior to reconstruction due to irreversible ischemic damage. The transverse colon was used in 88 patients, the left colon in 19, and the right colon in four.

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