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May 1995

Invited Commentary

Author Affiliations

New York, NY

Arch Surg. 1995;130(5):509. doi:10.1001/archsurg.1995.01430050059009

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Surgical treatment of esophageal atresia spans five decades. The experience reported from the James Whitcomb Riley Hospital for Children reflects the results of technical refinement and the emergence of pediatric anesthesia and neonatology. Through cooperative efforts, a formerly fatal condition is one in which cure is routinely effected.

The classic presentation, excess salivation, was noted in only 37% of the infants in this series, which probably reflects the contemporary use of prenatal ultrasonography with anticipation of the diagnosis and immediate attention to secretions. Only seven patients (two with type B anomalies and five with type D anomalies) had proximal fistulas. Diagnosis of these rare variants has been enhanced by preoperative bronchoesophagoscopy. Endoscopy is also useful in patients with type C anomalies and a trifurcation fistula coming off the carina. This lesion has proved to be troublesome to reconstruct, with a tendency for the distal esophagus to retract into the mediastinum

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