DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.008

Pages: 2432-2440

Background: Type I esophageal atresia (EA) according to the Gross classification corresponds to pure esophageal atresia without tracheoesophageal fistula (TEF), accounting for approximately 8–10% of all EA cases. This variant is invariably associated with a long esophageal gap that precludes primary anastomosis, thereby necessitating a staged approach culminating in delayed esophageal replacement. Among the available reconstructive options, the reversed gastric tube (RGT) technique, first described by Gavriliu, has gained recognition as a dependable method owing to its robust vascular supply, adequate luminal diameter, and adaptable conduit length. Case presentation: We report the case of a 4-year-old male child with long-gap type I EA who underwent cervical esophagostomy and feeding gastrostomy during the neonatal period. Following rigorous nutritional optimization and comprehensive preoperative assessment including gastrografin opacification studies demonstrating a well-calibrated stomach with a greater curvature measuring 217 mm and a proximal esophageal remnant of 147 mm the child underwent definitive esophageal replacement using the Gavriliu reversed gastric tube technique. The postoperative course was uneventful, with a contrast swallow study on postoperative day 8 confirming anastomotic integrity without leak or stenosis. Oral feeding was progressively resumed and the patient was discharged on postoperative day 14 in good general condition. Discussion: The Gavriliu reversed gastric tube remains a relevant and reliable alternative to other esophageal substitution techniques in children. Recent literature, including the 2021 ERNICA Consensus Conference recommendations, the 2023 Bambino Gesù case-control study, the 2024 Lausanne 33-year comparative review, the 2025 JIAPS decade-long series, and a 2026 Syrian case report, consistently demonstrates the safety and efficacy of this approach with satisfactory medium- and long-term functional outcomes. Conclusion: The