Aim of study: Analysis of mortality and morbidity of infants with long-gap esophageal atresia treated during 1992 to 2001. Methods: Retrospective analysis of hospital charts of patients. Results: 109 infants with esophageal atresia were operated on, 34 of them having long-gap (LG) esophageal atresia. Compared to infants with normal distance of esophageal stumps (non-LG), those with LG had significantly lower birth weight (2238 g vs. 2606 g), lower gestational age (36.2 vs. 38 weeks) and higher occurrence of imperforate anus (26.5 vs. 10.7%) and duodenal atresia (17.3 vs. 4%). In the LG group the incidence of anastomotic leak was 20.6%, stricture 26.5% and septic complications 64.7%. The incidence of gastroesophageal reflux was higher in non LG patients (33.5%) than in LG (23.5%). The LG patients were ventilated (25.2 vs. 13.8 days) and hospitalized (110.3 vs. 42.9 days) longer. Ten (29.4%) patients with LG died. All of them were from the group of 20 patients with delayed anastomosis performed or planned. The most frequent cause of deathwas sepsis. There were no deaths in the groups with primary anastomosis or esophageal substitution (7 infants each). Conclusions: Long-gap between esophageal stumps is a negative prognostic factor in the studied group. An attempt at higher proportion of primary anastomoses and shorter interval of waiting for stumps prolongation before delayed anastomosis might decrease the length of necessary intensive care support and septic complications that were the principal cause of death in our series.

        Key words: long-gap esophageal atresia, esophageal substitution, primary anastomosis, leak stricture, gastroesophageal reflux, mortality