ELONGATION OF BOTH ENDS BY STRETCHING TECHNIQUE

Ladies and gentlemen, this the 5 months, uh, boy suffered from a period of. We do the stretchy technique for more than 44 months, and then we're going to do the surgery. We can see the video. Thanks. This is a patient with long gap esophagealtricia, gross type A. After performing the gastrostomy, we use preoperative stretch and technique to prolong the proximal and distal esophageal segments by Bi to achieve primary anastomosis. After entering the thoracic cavity, identify the proximal esophageal pouch and gently mobilize it. It is important to be careful with this dissection to not injure the members trachea, which is lying adjacent to the proximal esophagus. Then is mobilization of the distal esophageal pouch. Sometimes the distal esophageal pouch is not easy to be found in pure esophageal trissa, so it is important to be gentle in this mobilization to protect the IVC and the vagus nerve fibers which are usually seen losing along the trachea and along the distal esophagus. But we can see the two segments are still widely separated. The anastomosis is hard to achieve because of the long gap, around 4 centimeters. So we performed lividities for both proximal and distal segments. 3 circles for proximal segment and 4 circles for distal segment. It is important to hold the hook steadily when performing myotomies to avoid injury of the layer of mucosa membrane, which may lead to esophageal perforation. Very fast. Resect the top tissue. Two segments are ready for anastomosis. First, to suture the posterior row using 55 0 polydioxinin. Remember to suture the whole layer of esophagus. Because of the long gap, there still existed a certain tension when performing anastomosis. So it is important to perform gently for this procedure. Here, we suggest the sutures tied by knot guide and using the grasping facades after finishing the first knot. Once the posterior row is sutured, an eight French tube is then inserted through the infant's nares across the esophageal anastomosis and into the stomach. The anterior portion of anastomosis is then completed in an interrupted fashion. After completing the anastomosis, check that everything is right. Confirm that no bleeding, no leakage, no injury of surrounding tissues, and so on. Then a small elastic drain is inserted through one of the incisions and a positioned near the anastomosis. This is an esophagram at one month's postoperative days showed no anastomotic leakage nor severe stenosis, but complicated with the gastroesophageal reflux. This is an esophagram at 6 months post-operative days which demonstrating the shape of reconstructed esophagus can be much better than several months ago. Thank you. Thank you.