Thoraoscopic repairs of congenital esophageal atresia with tracheoesophageal fistula

Abstract

Objective To evaluate the methods and efficacies of thoracoscopic repairs of congenital esophageal atresia with tracheoesophageal fistula (EATEF) in neonates. Methods A retrospective review was performed for 54 patients undergoing thoracoscopic repairs of esophageal atresia from July 2013 to July 2015. There were 32 boys and 22 girls with a mean age range of 1-12 (5.17±2.32) days and a mean weight range of 2.0-3.79 (2.85±0.44) kg. And 13 type IIIA and 41 type IIIB congenital esophageal atresia were diagnosed preoperatively by esophageal scintigraphy. Results Among them, 51 patients underwent one-stage thoracoscopic repairs successfully. There were 3 cases of conversion into open thoracotomy. The mean operative duration was 94-208(138±30) min. Two patients underwent fistula ligation due to proximal esophageal fistula. Three cases had esophageal incision due to distal esophageal stenosis. Two patients underwent anastomosis above right aortic arch while complicated with right aortic arch anomaly. Among 9 cases of anastomotic leak, death occurred as a result of treatment withdrawal (n=2) and respiratory failure from severe pneumonia (n=2). There was one case of recurrent esophagus-trachea fistula. Four patients were cured by intravenous nutritional supports. And 49 cases were cured and no complications occurred during a follow-up period of 4-28 months. Five cases of anastomotic stenosis recovered well after esophageal dilatation. Conclusions Thoracoscopy is both safe and effective for EATEF. With better exposure and easier handling, associated esophageal malformation can also be satisfactorily managed. Inclined planar clipping of esophagus and anastomosis reduces the occurrence of anastomosis stenosis. Its outcomes are dependent upon operative experiences and skills. Also anesthetic cooperation is also important. Key words: Esophageal atresia; Video-assisted thoracic operation; Neonates