Experiences in the treatment of esophageal atresia with Rehbein's olive technique

During the past few years four children with esophageal atresia without lower fistula were treated with the thread-and-olive method according to Rehbein. Our experiences indicate that excellent results can be achieved if the thread is inserted early, endoscopically, and olive bougienage is performed at short intervals. Tracheoscopy should be mandatory prior to the start of treatment, since we observed an upper fistula in three of four cases. Endoscopic thread insertion may lead to perforation of the main bronchus; control tracheo-bronchoscopy must therefore be done immediately following insertion. Perforation of the main bronchus turned out to be harmless, so the maneuver can be repeated after a few days. Two of the four infants died of congenital malformations. Therapy was not related to the fatal outcome in either case. One of the survivors has practically normal esophageal motor function with proven propulsive peristalsis. Esophageal stenosis had to be resected in the second survivor; this was followed by massive gastroesophageal reflux with esophagitis and disturbed gastric motility, rendering subsequent fundoplication and pyloroplasty necessary.