Motility function of the esophagus before primary anastomosis in esophageal atresia

Two patients with a long gap esophageal atresia without tracheoesophageal fistula underwent an esophageal manometric study before primary anastomosis and one of them underwent an identical study after operation. Before operation both patients showed peristaltic contraction in the proximal esophagus when swallowing which was always followed by a coordinated contraction of the distal esophagus the same as in that of the normal esophagus. These peristaltic contractions induced a reflex relaxation of the lower esophageal sphincter (LES). After operation the manometric studies of the repaired esophagus demonstrated an abnormal esophageal motility, with simultaneous contractions occurring when swallowing in the proximal to the distal esophagus. In addition, the reflex relaxation of LES was incomplete. These data suggest that even if the intraluminal continuity is defective, the esophageal motility function is not disturbed in the proximal to distal esophagus in preoperative esophageal atresia, and that intraoperative mobilization and denervation may be suggested to be an important factor in esophageal dysmotility even when esophageal atresia is successfully repaired.