Very long gap esophageal atresia successfully treated by esophageal lengthening using external traction sutures

Long gap esophageal atresia: an Australian experience

“…Retention of the esophagus was felt to be ideal by most of the surgeons, and different elongation procedures were developed to achieve this. Proximal and distal myotomies [5,24], mechanical bougienage [6,25,26], distal pouch mobilization [7], multistaged extrathoracic esophageal elongation [8], upper pouch flap [27], or combination of them [28] was used for that purpose. Data have shown that the esophagus can withstand high degree of tension and that has been emphasized in multiple reports [9,14,29].…”

Histological study of the elongated esophagus in a rat model

“…Similarly to several surgical techniques used for esophageal elongation (1)(2)(3)(4)(5)(6)(7)(8)(11)(12)(13)(14)(15)(16)(17), in this study the esophagus was elongated by traction as well. To the best of our knowledge, this is the first study to clarify which part of the esophagus was elongated by traction.…”

“…Esophageal elongation by traction suture has been used for the management of long-gap esophageal atresia (EA) in pediatric patients (1)(2)(3)(4)(5)(6)(7)(8)). Foker's method is one of the surgical techniques used to elongate the esophagus.…”

Long gap esophageal atresia: lengthening technique and primary anastomosis

“…The original technique described placing the sutures extraluminally to avoid leak and mediastinitis [6]. However, this did not prevent pneumothorax and leakage in several studies [2,3]. The main problem was that the traction sutures usually cut through the esophagus and cause leakage and disruption of traction [2][3][4][5][6][7].…”

“…It is still the opinion of most surgeons that the native esophagus is the best conduit [1]. There have been several reports in infants with long gap esophageal atresia of successful mechanical esophageal elongation using Foker technique and its application in clinical practice [2][3][4][5][6][7]. The major drawback with this technique is that the traction sutures may cut through the esophagus in many cases [2,3].…”