Long-term follow-up circular myotomy for esophageal atresia.

Between January 1976 and March 1979, esophageal atresia was successfully repaired in six infants with circular myotomy (Livaditis technique) and end-to-end anastomosis. Children were 1 day-6 mo in age and weighed 2.4 to 8.0 kg at the time of repair. Four children required one and two children required two circular myotomies in the proximal esophagus to bridge gaps between esophageal ends, which varied from 1.2-3.0 cm. Follow-up has been 1-4 yr (mean-3 yr). Operative complications included: opening of the mucosa at myotomy (2) and anastomotic leak (2). Subsequently, three children developed anastomotic stricture which required dilatation. Current x-rays show ballooning of the esophagus at the myotomy site during swallowing in all. However, the esophageal diameter at the myotomy site was never more than 2 cm greater than that of the distal esophagus. In the three children with anastomotic stricture, mucosal ballooning was not greater than in the others. During follow-up, weights have ranged from the 3rd to the 50th percentile for age. Swallowing has been good in 4, fair in 1 (dilatation still required), and poor in 1 (oropalatal deformities necessitate gastrostomy feedings). Circular myotomy offers a safe means of esophageal lengthening. Complications directly related to the myotomy are minimal (mucosal tear) and should be recognized at operation. Ballooning of the mucosa at the myotomy site is a common late finding but diverticulum formation has not occurred. Swallowing and esophageal motility are similar to other children who have had esophageal atresia repair.