Esophageal Substitution

Long gap esophageal atresia and esophageal replacement: moving toward a separation?

“…Long gap has been arbitrarily defined as either 2 or more centimeters or 2 vertebral body spaces between the 2 esophageal pouches. 1,2,5,[8][9][10][11][12][13]15 Other investigators define a gap of 3.5 cm or more an "ultra long gap." 5,14 Gaps 2 cm or less are considered amenable to primary repair; however, when the gap is 3 cm or more, the complication rate is significantly higher.…”

“…Options for esophageal reconstruction have long included use of native esophagus or replacement with stomach, colon, or small intestine. 1,2 Moreover, esophageal replacement often has to be delayed to 6 to 9 months of age. Although it is generally accepted that the best results are obtained if native esophagus is preserved, this may be difficult to achieve.…”

Esophagus Tissue Engineering: Hybrid Approach with Esophageal Epithelium and Unidirectional Smooth Muscle Tissue Component Generation In Vitro

“…In patients with long-gap atresia, surgical approaches such as (a) delayed repair (primary hitching of the esophagus end to the prevertebral fascia or the Foker technique), myotomy, and (b) esophageal replacement with either gastric, jejunum, or colon transposition have provided possible solutions. [2][3][4] However, these strategies are frequently associated with a high rate of short-and long-term complications that include leakage, stricture, elongation, and gastro-esophageal reflux. [5][6][7] Tissue engineering of the esophagus could overcome these limitations and offer viable alternatives to these approaches.…”

Extrathoracic esophageal elongation (Kimura's technique): a feasible option for the treatment of patients with complex esophageal atresia

“…If the gap improves after 2 to 3 months, we perform a "delayed primary anastomosis," but if the gap does not improve, or if the patient does not tolerate the continuous suction (recurrent aspiration, severe lung disease, etc), we perform a "primary esophagostomy." After that, if the lower esophageal pouch reaches the area of the carina under none, or moderate, tension (measured under fluoroscopy with a radiopaque instrument through the gastrostomy), we initiate the EEE process, whereas if the lower pouch is far from the carina (or completely absent), we perform an esophageal replacement [30][31][32]. The primary esophagostomy was always a cervical esophagostomy; we never performed an elongation at the first time.…”