Lateral proximal esophagostomy and bouginage for the management of type-A esophageal atresia: a case series

Abstract

Introduction

Type A esophageal atresia (EA) is a rare congenital anomaly. Multiple surgical approaches and techniques have been proposed for its treatment, highlighting the complexity of its correction.

Case presentation

Case 1 was of a female infant delivered at 35 weeks of gestation (weight, 2.7 kg; height, 47 cm; Apgar, 8–8), diagnosed with Type A EA and duodenal atresia. At 4 days of age, lateral proximal esophagostomy (LPE), duodenal membrane resection, and gastrostomy were performed. The patient was discharged after 36 days, with the parents instructed to perform bouginage. Owing to the pandemic, esophageal anastomosis was performed at 2 years of age. Subsequently, two esophageal dilatations were required; Nissen fundoplication with closure of gastrostomy and LPE were performed 4 months later. At approximately 5 years of age, the patient showed no difficulties in feeding. Case 2 was of a male infant delivered at 37 weeks of gestation (weight, 2.8 kg; height, 50 cm; Apgar, 8–9), diagnosed with Type A EA with VACTERL association. Gastrostomy and LPE were performed at 6 and 26 days of age, respectively; the patient was also discharged, with the parents instructed to perform bouginage. Due to malnutrition, esophagoplasty was performed at 1 year and 10 months. Subsequently, two esophageal dilations were performed, followed by closure of gastrostomy and LPE after 2 and 7 months, respectively. At the 3-year follow-up, the patient exhibited no feeding difficulties.

Conclusion

Lateral proximal esophagostomy and bouginage appear to be a feasible option for the management of type-A esophageal atresia.