Standard and Staged Thoracoscopic Repairs of Esophageal Atresia and Tracheoesophageal Fistulas

Abstract

Abstract Introduction: Tracheoesophageal fistula (TEF) is a common congenital anomaly of the respiratory tract, which is seen in ∼1 in 3500 live births. Typically, TEF occurs with esophageal atresia (EA) and may be associated with other congenital heart or genitourinary anomalies as part of the VACTERL or CHARGE syndromes.1 Common complications after EA and TEF repair include esophageal stricture (35%), anastomotic leak (16%), and recurrent fistula (3%).2 Materials and Methods: Standard TEF repair: The standard TEF repair begins by positioning the patient in a semiprone position with 40°–45° of rotation. Three ports are utilized for optimal control and observation. First, the azygous vein is identified and ligated. During dissection of the esophagus, it is crucial to avoid damaging the vagus nerve, which can be seen near the lower pouch. Often, a preoperative bronchoscopy with insertion of a guidewire can help identify the fistula for accurate ligation. Subsequently, the anesthesiologist can aid in identi...