Until 1940 congenital esophageal atresia was a uniformly fatal congenital anomaly. At that time Haight1 first successfully closed the tracheoesophageal fistula and performed a primary esophageal anastomosis. This operation was quickly established as the treatment of choice, and in many hundreds of cases has been successfully done, with an acceptable mortality rate. However, in some of these anomalies, usually estimated at about 10%, primary anastomosis is impossible because of the shortness or poor development of the distal segment.
The best method of salvaging these few cases has not been clearly established. The same problem, that of esophageal replacement, whether for atresia, carcinoma, or chemically induced stricture, has intrigued surgeons for generations. The first successful method, a skin-lined subcutaneous tube, has been abandoned. Longmire2 replaced the esophagus with a segment of jejunum placed subcutaneously. Rienhoff and Potts used stomach by the same route. Sweet3 mobilized the stomach and