A true primary repair can be defined simply as joining the two esophageal ends together and leaving the stomach entirely below the diaphragm. The stomach must remain in the abdomen where it belongs. Furthermore, no circular incision is made through the esophageal muscles. Circular myotomies are not used because of the potential for complications from the weakened esophageal wall. With the esophageal ends joined together and the stomach below the diaphragm, the child has by far the best chance of eating normally.
Later problems are also much less likely to occur.
The result of a true primary repair is always the same, the esophageal ends are joined together and the stomach kept below the diaphragm. For most of these infants it can be done at one operation. The two esophageal ends can be brought together, even sometimes under a great deal of tension and the repair will still hold together. Therefore, even babies whose gaps are rather long can have an initial true primary repair. Stimulating the esophagus to grow It is not always possible, however, to do a true primary repair initially.