Long-gap esophageal atresia: experience with Kato's instrumental anastomosis, with cervicothoracic procedure and primary anastomosis, and with retrosternal colonic interposition.

Twenty-four patients with long-gap esophageal atresia have been treated since 1960. Instrumental anastomosis according to Kato was applied in seven cases, cervicothoracic procedure with primary anastomosis followed extended mobilization of the upper and lower pouches in four cases, and retrosternal colonic interposition was performed in 13. Currently, treatment of long-gap esophageal atresia, Vogt-type II, should include first a gastrostomy and, 4-6 weeks later, if the baby is thriving, extended cervicothoracic mobilization of the upper pouch up to the larynx and of the lower pouch down to the cardia, followed by primary anastomosis. If primary anastomosis cannot be performed, both pouches should be adapted, by necrosing sutures according to Santulli, and perforated with a thin mandrin. Thus, esophageal replacement is necessary only in exceptional cases, for which retrosternal colonic interposition is recommended.