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Esophageal Replacement for Long-Gap Esophageal Atresia in a Resource-Limited Setting

Saula PW, Kuremu RT

School of Medicine, Moi University

Correspondence to: Dr. Peter Walter Saula, P.O Box 1998 – 30100 Eldoret. Email: saulapw@yahoo.com



The management of esophageal atresia in a resource-limited environment is plagued with challenges that often lead to poor outcome. The diagnosis and management of babies with long-gap esophageal atresia adds a new dimension to these challenges. We report the success of esophageal replacement surgery for a baby with long-gap esophageal atresia in a resource-limited setting. One year after surgery, she was eating well and her weight gain was appropriate.

Keywords: Long-gap, Esophageal Atresia, Esophagoplasty, Resource-Limited

Ann Afr Surg. 2015; 12(2): 104-8.


Management of esophageal atresia (EA) in a resource-limited environment is a major challenge to the pediatric surgeon. Esophageal atresia occurs in various forms in approximately 1 in every 3000 – 4500 live births (1). Although almost 100 variants of this anomaly have been described, EA with distal tracheo-esophageal fistula (TEF) is the commonest, occurring in approximately 86% of cases. Pure esophageal atresia (isolated EA with no fistula) occurs in approximately 8% of cases (1). Survival of babies with EA is firmly hinged on effective pre-and post-operative management. Many pediatric surgical units in sub-Saharan Africa have reported survival of 10 - 40% (2).

In long-gap esophageal atresia (LGEA), the interval between the upper pouch and the distal esophagus does not permit primary anastomosis at surgery. Fortunately, this is rarely encountered in EA with distal TEF. However, it is the norm in pure EA (3).

The diagnosis of pure EA is confirmed by the inability to pass a naso-gastric tube into the stomach and a gasless abdomen on plain x-ray (Figure 1). The surgical management of babies with this variant is equally challenging and controversial (3). The majority of pediatric surgeons consider delayed primary anastomosis of the native esophagus the optimum approach, a strategy that demands meticulous nursing care, physiotherapy and proper nutrition by supervised gastrostomy feeding (4). Whereas this care can easily be provided in the developed world, in Sub-Saharan Africa, it is still a challenge. But even in the est