An alternative to an interposition procedure in esophageal atresia.

The suture fistula technique for long gap esophageal atresia with tracheoesophageal fistula (TEF) was described by Shafer and David in 1974. Schullinger in 1982 reported five cases with fistulization occurring in four cases. In the past 2 years, we have used this technique in four infants who ranged from 1,200 to 1,700 g and in one infant who weighed 2,900 g. Successful luminal continuity was established in four of the cases and a temporary fistula in the fifth, but this closed. The latter did require a repeat thoracotomy with resection and end-to-end suture 28 days after the original suture-fistula technique. She is well. In a recent full-term infant this technique was used successfully too. All procedures were done transpleurally. We have found that fistulization usually occurs about the eighth or ninth day. This is apparent when milk, given by gastrostomy, appears in the mouth. To date, one of our children (K.C.) has required an antereflux procedure.