[Routine gastrostomy in esophageal atresia]

Contrary to Kiely and Spitz we have been using gastrostomy in almost all cases of oesophageal atresia treated with primary anastomosis. Gastro-oesophageal reflux has never been a major problem and during 25 years of personal paediatric surgical experience we have never performed any type of antireflux surgery. To confirm this we have followed up 71 out of 77 survivors who underwent primary anastomosis and gastrostomy in 3 Departments of Paediatric Surgery. The patients were examined 13 months to 17 years, in average 7 years postoperatively. 50 children were free from symptoms, the remainder complained of increased susceptibility to broncho-pulmonary infections. These children were younger than 4 years. X-ray controls could be performed in 50 patients. The vast majority showed motility disorders of the oesophagus, well known as Yo-Yo-phenomenon with swaying of the dye and delayed clearing of the oesophagus. Distinct gastro-oesophageal reflux was detected in 3 of the 50 cases, but there were no signs of oesophagitis or stricture and the patients were free of symptoms. There were no late strictures and no late mortality. We consider proper conservative management especially with oblique positioning as used in hiatal hernias most important in the treatment of the oesophageal motility disorder as well as gastro-oesophageal reflux in the early postoperative period and advocate routine gastrostomy and insertion of an endless thread for routine bougienage.