An improved technique for circular myotomy in long-gap esophageal atresia

Circular myotomy has allowed the surgeon to establish esophageal continuity in early infancy in patients with long-gap esophageal atresia. This report describes the use of a #5 Fogarty balloon catheter, passed by the surgeon into the proximal esophagus to facilitate the myotomy. The catheter is passed through a pursestring suture placed at the tip of the proximal esophagus. The balloon is inflated to fill but not distend the lumen. The myotomy is performed approximately two cm proximal to the esophageal end and; upon its completion, it will provide 1 to 1.5 cm of additional length. The advantages of the surgeon placing the catheter into the esophagus include: complete control of the balloon size and position, and the ability to use the catheter to manipulate the proximal esophagus atraumatically.