Surgical aspects of chronic post-thoracotomy pain

Feasibility of thoracoscopic repair of esophageal atresia with distal fistula

BACKGROUND/PURPOSE

Evaluation of the feasibility of thoracoscopic correction of esophageal atresia with distal fistula.

METHODS

Eight consecutive neonates with esophageal atresia and distal fistula were treated thoracoscopically. Mean birth weight was 3,048 g (range, 2,140 to 3,770). The patients were intubated endotracheally and placed in a 3/4 left prone position. Three cannulae were inserted along the inferior tip of the scapula. CO(2) was insufflated at a pressure of 5mm Hg and a flow of 0.5 L/min. The fistula was either clipped or ligated. The proximal esophagus was opened and an anastomosis was made over a 6F or 8F nasogastric tube with interrupted 5-0 Vicryl.

RESULTS

All procedures were completed thoracoscopically without major peroperative complications. The mean operating time was 198 minutes (range, 138 to 250). One patient had a major leak, resulting in a stormy postoperative course, but the leak healed on conservative treatment. This patient and 3 others had stenosis requiring dilatation, respectively, 3, 6, 12, and 1 times. The babies were fed after a median period of 8 days. The median hospital stay was 13 days.

CONCLUSIONS

Thoracoscopic repair of esophageal atresia with distal fistula is feasible. Larger series are needed to determine the exact place of the thoracoscopic approach.