Thoracoscopic repair of pure esophageal atresia
Epublication WebSurg.com, Dec 2017;17(12). URL: http://websurg.com/doi/vd01en5143
A full-term baby weighing 2.8 kg was diagnosed with pure esophageal atresia. No other associated anomalies were found by abdominal sonography and echocardiography. The primary anastomosis was completed thoracoscopically after mobilization of both esophageal pouches. The patient was placed in a prone position at the edge of the operating table. A 5mm, 30-degree angled scope was introduced one fingerbreadth below the lower angle of the scapula. Two 3mm working ports were also inserted; the first in the same costal space as the camera port 3cm from the middle line and the second as high as possible in the axilla. A thin fibrous strand was found connecting both ends of the esophagus. The azygos vein was left intact. Blunt dissection was used throughout the whole procedure to preserve the aortic branches to the lower pouch, dissecting in between them. Without traction, the distance between both pouches was approximately 4cm or 4 vertebral bodies. No tracheoesophageal fistula (TEF) was identified. Nine polyglactin 5/0 sliding tumble square knots were used to complete the anastomosis. The operative time was 85 minutes. The postoperative period was uneventful. Nasogatric tube feeding started on postoperative day 2, and the patient was discharged on postoperative day 6 after performing a contrast swallow test ensuring that there is no leakage.