Thoracoscopic Division of H-Type Tracheoesophageal Fistula

Abstract

Abstract Introduction: H-type tracheoesophageal fistula repairs have historically been approached from either a low cervical or a high thoracic incision, both of which are associated with attendant problems. Chief among these is adequate identification and isolation of the fistula; it is commonly located at the level of the thoracic inlet. The thoracoscopic approach provides a magnified improved view of the relevant anatomy and pulls the operative field to a site remote from the recurrent laryngeal nerve. Methods: A 3-day-old 2.2 kg baby girl was referred for repeated coughing with feeds and an esophagram, which demonstrated an H-type tracheoesophageal fistula. An echocardiogram identified an atrial septal defect. In the operating room, rigid bronchoscopy showed a normal airway with the exception of a fistula in the posterior wall of the trachea; a #3 Fogarty balloon catheter was inserted through the fistula and the balloon inflated. Traction on the catheter wedged it into the esophageal lumen at the posi...