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Question 12#

The initial treatment for a pure EA (no fistula) is:

A. Repair of the EA
B. Repair of the EA with placement of a gastrostomy
C. Repair of the EA, Nissen fundoplication, and placement of a gastrostomy
D. Gastrostomy alone

Correct Answer is D

Comment:

Primary EA (type A) represents a challenging problem, particularly if the upper and lower ends are too far apart for an anastomosis to be created. Under these circumstances, treatment strategies include placement of a gastrostomy tube and performing serial bougienage to increase the length of the upper pouch. This occasionally allows for primary anastomosis to be performed. Occasionally, when the two ends cannot be brought safely together, esophageal replacement is required, using either a gastric pull-up, reverse gastric tube, or colon interposition.