Methods: The distal esophagus was exteriorized on to the left upper abdominal wall (abdominal esophagostomy) in 15 babies who had esophageal atresia with or without tracheo-esophageal fistula. The indications for this procedure were long gap atresia with or without tracheoesophageal fistula in which primary anastomosis was not possible and a major anastomotic dehiscence requiring cervical esophagostomy and gastrostomy. In all these patients a decision to replace the esophagus had been made, and a cervical esophagostomy was constructed. The distal esophagus was mobilized either from the thorax if thoracotomy had been done or by a transhiatal abdominal route.
Conclusions: Advantages of the abdominal esophagostomy include absence of gastroesophageal reflux, no indwelling catheter, early institution of enteral feeds, intermittent catheterization for feeding, easy nursing care, and no stomal complications. In addition, this procedure allows the entire stomach to be available for esophageal replacement and retains the natural gastroesophageal junction and the lower esophagus for anastomosis to any bowel segment being used for the esophageal replacement.