Diverticulum formation after circular myotomy for esophageal atresia

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Updated: Oct 29, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
09:40

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

Published on: April 17, 2020

J B Otte, P Gianello, F X Wese

    Journal of Pediatric Surgery
    |February 1, 1984
    PubMed

    Insights

    The Livaditis technique for esophageal atresia using circular myotomy can lead to complications like strictures or diverticula. Careful long-term follow-up is crucial for patients undergoing this procedure.

    Area of Science:

    • Pediatric Surgery
    • Thoracic Surgery
    • Congenital Abnormalities

    Background:

    • Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a complex congenital anomaly.
    • Surgical correction often requires techniques to bridge the esophageal gap, especially in longer-gap EA.

    Observation:

    • This study reviewed six cases of EA treated with circular myotomy of the upper pouch (Livaditis technique) for end-to-end anastomosis.
    • All six patients had a lower TEF and underwent surgery between 15 and 96 hours after birth without preoperative pouch elongation.

    Findings:

    • Three patients had uneventful outcomes, while three developed mild strictures responsive to dilatation.
    • Two patients developed diverticula, one causing acute respiratory distress and the other severe dysphagia, necessitating esophageal replacement.
    • Complications included ballooning at the myotomy site, strictures, and diverticula formation.

    Implications:

    • The Livaditis technique for EA requires vigilant early and late postoperative monitoring.
    • Close surveillance is particularly important for patients with anastomotic strictures or associated tracheomalacia.
    • Management of EA complications may involve dilatations or, in severe cases, esophageal replacement.

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