Cervical esophagogastric anastomosis via a retrosternal gastric conduit for adult type A long-gap esophageal atresia after 18 years of gastrostomy: A case report

Background Adult reconstruction for type A long-gap esophageal atresia (LGEA) after prolonged gastrostomy dependence is rare. We report an adult patient who had been reliant on gastrostomy since birth and regained durable oral intake after planned 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 through 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; her body weight increased by 3 kg after 3 months. Conclusion Durable oral feeding is feasible after long-term gastrostomy in adult type A LGEA when TEF is absent and the reconstruction route and anastomotic technique are individualized for reach and perfusion. The retrosternal route is reasonable when posterior mediastinal adhesions or conduit reach are concerns; candidacy should be determined individually.