Oesophageal anastomosis without bougienage in isolated atresia--do the segments really grow while waiting?

Four cases of isolated oesophageal atresia, in which a successful oesophageal anastomosis was achieved without bouginage, are reported. The anastomoses were performed at ages from one month to three and a half months. No certain growth of the segments could be observed. However, in the cases, where the operation was performed after a longer waiting period, the lower segment was surprisingly thick walled, which made the anastomosis possible. A single Livaditis myotomy was required in three cases and a double myotomy in one. All patients needed Nissen's fundoplication because of gastro-oesophageal reflux, which caused stricturation of the anastomosis and oesophagitis. After the follow-up period of 1.3 to 2.5 years, two patients had an excellent result, one patient a fair result and one patient had died of his severe cardiac anomaly associated with Down's syndrome.