Esophageal atresia treated by electromagnetic bougienage and subsequent repair☆

Abstract 

There are some infants with esophageal atresia with or without tracheoesophageal fistula in whom the esophageal segments are too far apart to allow safe primary anastomosis without tension. During the past 20 yr the most widely used approach in these cases has been temporary marsupialization of the blindly ending upper esophagus to the neck, followed later by interposition of a segment of colon.¹ Howard and Myers² introduced manual bougienage for the upper pouch to elongate it and accomplish a delayed primary anastomosis. This technique was later used with some success in other institutions.³ Rehbein⁴ placed bougies in both esophageal segments and applied traction sutures threaded through the ends of the pouches that were pulled together slowly.

This paper describes another method used in four infants with esophageal atresia. Metal bougies (“bullets”) were placed into the two ends of the esophagus. An electromagnetic field was then used to pull the bullets together to elongate the esophageal ends in order to allow esophageal anastomosis, which had been impossible previously. Cases 1 and 2 were discussed in a previous report⁵ and therefore will not be described in as much detail as Cases 3 and 4. Certain refinements in the method were developed in treating Cases 3 and 4. For example: (1) The sump suction tube attached to the upper-pouch bullet was brought out through a lateral pharyngotomy instead of the nose. (2) The stem of the lower-pouch bullet was brought through a small separate stab incision in the midline to direct it straight upward. Leakage around the gastrostomy site proved troublesome when it was brought through the same opening as the gastrostomy tube. (3) The lower-pouch bullet was placed “by feel” into the distal esophagus, not requiring anesthesia. Initially this was done under direct endoscopic visualization using anesthesia. (4) Placing of the lower-pouch bullet, which has a flexible steel stem, was accomplished by sliding a rigid metal tube over the flexible cable, using this as a handle to direct the bullet into the distal esophagus.

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