Congenital Esophageal Atresia Treated by Modified Esophageal Myotomy

13 patients with congenital esophageal atresia were admitted from April,1982 to A'ugust,1983.9 of them,aged 1 to 15 days,received the modified Livaditis esophageal myotomy.8 patients had a distal tracheoeso.phageal fistula and one had only isolated atresia.4 died after the operation either of severe pneumonitis (3 cases) or of cyanotic congenital heart disease (1 case).To reduce the tension of the anastomostic site,multiple myotomies of 1/3 to 1/2 cycle around the esophagus were made on the proximal pouch to obtain stretching during primary anastomosis,with an average elongation of 1.2 cm.Operative complications included the cutting of the mucosa (2 cases) and damage to the trachea (1 case).Yet the operations were accomplished after the repair of the injuries without other problems.A stretehing of 1.2 cm on an average is highly significant in redu.cing the tension at the anastomosis and achieving the decrease in anastomostic leak.In short this teehnique may provide a release of the tension with minimal interruption of blood supply and is applicable to most patients with the condition.