Cervical esophagogastric anastomosis using a retrosternal gastric conduit in an adult patient with congenital type A long-gap esophageal atresia after 18 years of gastrostomy: a case report.

backgroundDefinitive reconstruction in adulthood after 18 years of gastrostomy dependence for congenital type A long-gap esophageal atresia is extremely rare. We report an adult patient who had been reliant on gastrostomy since birth and regained sustained oral intake following definitive reconstruction, emphasizing the preoperative exclusion of tracheoesophageal fistula (TEF), individualized route selection, and tailored cervical anastomosis. CASE PRESENTATION: An 18-year-old woman with type A LGEA underwent neonatal thoracotomy without definitive repair, followed by gastrostomy. At 2 years of age, cervical esophagostomy was performed for recurrent aspiration. Preoperative computed tomography showed a markedly dilated proximal cervical esophagus with esophagostomy at the left neck and absence of intramediastinal esophagus. No tracheoesophageal fistula (TEF) was identified. Anticipating posterior mediastinal adhesions and difficulty in elevating the gastric conduit through the posterior mediastinum, we planned cervical esophagogastric anastomosis using a gastric conduit via the retrosternal route. An anastomotic leak and left pneumothorax occurred postoperatively but resolved with conservative management. Left recurrent laryngeal nerve palsy occurred without aspiration. She commenced oral intake on postoperative day (POD) 12 and was discharged on POD 21. She maintained stable oral intake, and her body weight increased by 3 kg at 3 months and by 10 kg at the latest follow-up (10 months).

conclusionDurable oral feeding is feasible after long-term gastrostomy in adult patients with type A LGEA when TEF is absent and the reconstruction route and anastomotic technique are individualized for adequate reach and perfusion The retrosternal route represents a viable option when posterior mediastinal adhesions or conduit reach are concerns; candidacy should be determined individually. However, these findings should be interpreted with caution because this report describes a single case, and further studies are needed to clarify the long-term outcomes of delayed reconstruction in adults with long-gap esophageal atresia.