Esophageal atresia with long gap

The definition of "long gap" is generally more than two vertebrae. At first, the gap of the esophagus is tried to be shortened using some devices for extension of both the upper and lower esophagus. Foker' s method is reported to be effective. There are several options using alternative organs, such as gastric tube, jejunal interposition, colonic transposition, and gastric transposition. Gastric transposition is one of the alternatives for replacing the esophagus using the whole stomach. This procedure can be performed trans-hiatally via the posterior mediastinum without thoracotomy. There have been several reports showing good results compared with other procedures. This method has the advantage of involving only one anastomosis, which is well vascularized and is associated with a low incidence of leakage. Briefly, the greater curvature of the stomach is mobilized by ligating and dividing the vessels in the greater omentum and the short gastric vessels. These vessels should be ligated well away from the stomach wall in order to preserve the vascular arcades of the right gastroepiploic vessels. The highest part of the fundus of the stomach is identified and pulled up through the posterior mediastinum into the neck.