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    • Can Distal Abdominal Esophagostomy Replace Gastrostomy in Esophageal Atresia?

    Wael Ghanem
    Pediatric Surgery Unit, Ain Shams University

    Background: Conventional gastrostomy is essential in long gap esophageal atresia with or without tracheoesophageal fistula and in postoperative major anastomotic dehiscence, but it has a lot of complications. Objective: The aim of this study is to assess the effectiveness of distal abdominal esophagostomy in replacing conventional gastrostomy. Patients and Methods: The distal esophagus was exteriorized on to the left upper abdominal wall (abdominal esophagostomy) in 12 babies who had esophageal atresia with or without tracheoesophageal fistula. The indications for this procedure were long gap esophageal atresia with or without tracheoesophageal fistula in which primary anastomosis was not possible and a major anastomotic dehiscence requiring cervical esophagostomy and gastrostomy. In all these patients a decision to replace the esophagus had been made, and a cervical esophagostomy was constructed. The distal esophagus was mobilized either from the thorax if thoracotomy had been done or by a transhiatal abdominal route. Results: All babies survived the procedure, 3 unrelated deaths occurred. Narrow distal esophageal stump recorded in one patient. No skin excoriation, no wound infection, no stomal retraction, nor vascular compromise of the distal esophageal stump had been recorded. No reflux of gastric contents through the distal esophagostomy. Intermittent catheterization for feeding found a great acceptability with the parents. Conclusions: Advantages of the abdominal esophagostomy include absence of gastroesophageal reflux, no indwelling catheter, early institution of enteral feeds, intermittent catheterization for feeding, easy nursing care, and no stomal complications. In addition, this procedure allows the entire stomach to be available for esophageal replacement and retains the natural gastroesophageal junction and the lower esophagus for anastomosis to any bowel segment being used for the esophageal replacement. Key Words: Distal abdominal esophagostomy, gastrostomy, esophageal atresia, long gap atresia, tracheoesophageal fistula, anti-reflux mechanism, gastroesophageal reflux, post-operative fistula formation.

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