الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Esophageal atresia (EA) is one of the challenging congenital anomalies characterized by interruption of the continuity of the esophagus which may be associated with tracheoesophageal fistula (TEF). EA is more common in males and has a lot of types according to the presence and the anatomical site of TEF.
EA may be associated with other congenital anomalies. The pathogenesis of EA is due to failure of the development of the septum which separates the trachea from the esophagus. Diagnosis of EA is suspicious in the prenatal period by the presence of polyhydramnios and a small or absent stomach with ultrasonography, also the presence of blind ended upper esophageal pouch could confirm the diagnosis.
Symptoms suspected of EA is observed shortly after birth and include excessive salivation regurgitation. Postnatal diagnosis is confirmed radiologically after insertion of NGT which coils in the upper esophageal pouch and the presence of air-filled bowel loops is suggestive of EA with distal TEF (Type C).
Operative management of EA is no longer considered a surgical emergency, but it is of greater importance to optimize the infant’s physiological status prior to surgery which may be with open thoracic approach or with thoracoscopy. Preoperative and postoperative neonatal care is the corner stone in management of EA specially in cases with staged repair.
Preoperative surgical planning and good assessment of the length of the gap between esophageal pouches are very crucial in cases of EA particularly in type (C) EA to avoid unbeneficial primary repair in cases with long gap and subsequent operative and postoperative complication.
The aim of our study was to predict long gap type (C) EA preoperatively by clinical examination i.e. (body weight – abdominal distension) radiological findings i.e. (relation of the upper pouch to T3 – width of upper pouch) and if primary anastomosis would be successful in neonates having EA with distal TEF.
Our study included 32 patients with type (C) EA, in whom 21 patients had primary repair and 11 patients had staged repair and the study was carried out during a one-year from June 2016 till June 2017.
With increased body weight and maturity, the gap length is short and primary repair is feasible, also when the upper pouch is at the level or below T3 the gap length is short. Some techniques could be performed on dilated upper pouch to reduce the gap length and making primary repair feasible.