Thoracoscopic correction of esophageal atresia in children in Dagestan

Abstract

Introduction. The authors share their experience in treating children with esophageal atresia (EA) using the thoracoscopic technique. Material and methods. 25 children with EA were operated on in N. M. Kuraev Children’s Republican Clinical Hospital in Makhachkala (Republic of Dagestan, Russia) in 2020–2022. 17 children had thoracoscopy; 13 were put primary anastomosis of the esophagus; 3 had gastrostomy after ligation of the tracheoesophageal fistula; in one child, who had no EA fistula, surgeonsput internal traction sutures on the proximal and distal ends of the esophagus without gastrostomy. Of 13 patients with primary anastomosis of the esophagus, 3 had conversion; in one patient without EA fistula, thoracoscopic esophageal anastomosis was put on the 6th day after internal traction sutures. Thus, the authors have analyzed outcomes in 10 patients with primary anastomoses and in one patient with delayed one who were operated on with the thoracoscopic technique. Results. Outcomes of treating children with EA after putting thoracoscopic anastomoses of the esophagus were evaluated. Discussion. On analyzing literature data on EA thoracoscopic correction, one can see good cosmetic effects at early and especially at late postoperative periods with low incidence of musculoskeletal deformity. A serious problem for most pediatric surgeons is the impossibility to create primary anastomoses in the neonatal period. In our case, the only obstacle was a large diastasis between segments of the esophagus. Yu. Yu. Kozlov et al. reported about a new approach applied in two newborns with EA: thoracoscopic traction elongation of the esophagus can be made without gastrostomy followed by esophago-esophagoanastomosis on days 5 and 6, respectively. They observed only stenosis of the anastomosis in both cases, what we also observed in one case. Conclusion. Thoracoscopic technique for esophago-esophagoanastomosis is less traumatic; it improves visualization of the surgical field, gives good cosmetic results and does not cause rough cicatricial changes and musculoskeletal deformities.