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The mortality of primary repair of esophageal atresia in infants without associated major anomalies who are mature by weight, has declined to acceptable levels. The same cannot be said of similar infants who are premature. The high mortality following primary repair in this group has led to the clinical trial of temporizing procedures designed to delay esophageal anastomosis, such as fistula ligation, fistula division and gastric division.
A limited experience with these procedures has not produced results which suggest that they will necessarily represent an improvement over primary anastomosis. The extrapleural approach to esophageal anastomosis was associated with a higher survival rate than the transpleural approach in the group of premature infants under study. This difference was more impressive among infants weighing less than 2,000 gm. In this group almost all survivors were treated by an anastomosis performed extrapleurally. The results in a series of premature infants treated by the extrapleural approach would appear to be the logical standard against which the described innovations in management can be measured.
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