Complete recovery without complications after reversed gastric tube esophagoplasty in an exceptional case of esophageal and anorectal atresia: a report from Syria

Introduction: Esophageal atresia (EA) is a congenital anomaly that becomes particularly challenging to manage in its long-gap variants, where primary anastomosis between the esophageal segments is not feasible. In such situations, esophageal replacement becomes necessary. Among the available options, reversed gastric tube esophagoplasty has gained recognition as a dependable reconstructive technique due to its robust vascular supply, sufficient luminal diameter, and its capacity to support long-term growth and function. Presentation: We describe the case of a child diagnosed with long-gap EA associated with an anorectal malformation. Owing to the severity of the esophageal defect, the patient underwent a staged management plan that ultimately culminated in reversed gastric tube esophagoplasty. Postoperatively, the patient demonstrated a smooth and stable recovery, with early initiation of oral feeding and appropriate functional behavior of the esophageal conduit. No complications were observed, including anastomotic leak, stricture formation, gastroesophageal reflux, or delayed gastric emptying. Discussion: The favorable postoperative outcome in this child underscores the effectiveness of reversed gastric tube esophagoplasty in managing complex cases of long-gap EA, particularly when compounded by additional congenital anomalies. Several factors likely contributed to the successful result, including meticulous preoperative optimization, careful conduit construction with attention to vascularity and diameter, and strategic surgical planning. This case supports existing evidence that gastric tube reconstruction can offer excellent functional results when performed within a structured, staged treatment approach. Conclusion: This case demonstrates that reversed gastric tube esophagoplasty is a reliable and effective option for esophageal replacement in long-gap EA, even when associated with other congenital anomalies such as anorectal malformation. Comprehensive preoperative preparation, precise technical execution, and thoughtful staging can collectively lead to optimal functional recovery and the avoidance of major postoperative complications.