J.Jpn. Surg. Soc.. 98(12): 1008-1012, 1997

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Feature topic

RECENT ADVANCE IN THE TREATMENT OF CONGENITAL ESOPHAGEAL ATRESIA AND CONGENITAL TRACHEAL STENOSIS

Advances in anesthetic management, neonatal intensive care and cardiovascular techniques for severe cardiac defects have permitted improved survival rate for esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) during the last two decades. In the treatment of EA-TEF, primary esophageal repair without staging or preliminary gastrostomy becomes popular among pediatric surgeons. In pure EA and long-gap EA with TEF, options for esophageal reconstruction include use of the native esophagus or replacement with colon or stomach. In considering the esophageal motility in patient's whole life, native esophageal reconstruction is the procedure of choice rather than esophageal replacement. Improved survival rates are noted irrespective of the traditional Waterston criteria, which now seem outdated.
The surgical treatment of congenital tracheal stenosis have started in the early ’80s. Resection of the stenotic trachea with end-to-end anastomosis has been available in the stenosis ranging less than 30％ of the entire trachea. However, the treatment of long segment tracheal stenosis is still controvertial. Various surgical techniques including balloon tracheal split, slide tracheoplasty, implantation of autografts of pericardium and costal cartilage have been attempted. In this review, we described our own experience in tracheoplasty using costal cartilage.

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