Long-gap esophageal atresia

Esophageal atresia is a rare congenital anomaly that occurs in 1 in 4,500 live births. The expected outcome is close to 100% survival, though this varies depending on birth weight, degree of prematurity, and associated anomalies (especially cardiac). Ideal surgical management consists of a primary end-to-end anastomosis between the upper and the lower esophageal remnants and division of a tracheo-esophageal fistula, if one is present. The vast majority can be corrected without difficulty soon after birth. However, this goal is not always easily achievable with all anatomical variants and the management of long-gap esophageal atresia remains a major challenge to the pediatric surgeon. In addition, there is controversy regarding the definition of a long gap and a general lack of consensus regarding which is the best technique. This is perhaps due to the fact that attempts to bridge the gap to allow a delayed anastomosis have led to the introduction of several interesting techniques, none of which are perfect.