Thoracoscopic repair of esophageal atresia with distal fistula - The way to go

Background: Esophageal atresia (EA) has always been considered the hallmark of pediatric surgery. In the past decade, mortality was primarily the result of associated diseases, and operative morbidity had greatly improved. Yet the consequences of opening the thoracic cavity remained unchanged. In the era of endoscopic surgery, a thoracic approach to EA has become feasible, but is it of benefit for the patient? Methods: Between May 2000 and June 2002, 13 neonates underwent thoracoscopic repair of EA. There were 12 boys and I girl. Mean gestational age was 36.9 weeks. Mean weight was 3093 g. Eleven children had associated anomalies. Results: All of the procedures were performed thoracoscopically. There were no intraoperative complications, although anastomosis was difficult in one patient due to an extensive distance between the two stumps. Mean operating time was 2.6 h (range, 1.45-3.5). Five short-term postoperative complications occurred. Four of the early patients had stenosis due to a too-small incision in the proximal pouch, which needed one or more dilatations, One of these children, as well together as one other child, had anastomotic leakage, which was treated conservatively. Late complications consisted of gastroesophageal reflux (n = 5) and tracheomalacia (n = 1); these conditions required endoscopic correction in, respectively, two and one cases. Feeding by nasogastric tube was started after 3.5 days (mean), and total oral feeding was possible after 8.6 days (mean). Mean hospitalization was 12.2 days. Mean follow-up was 15.2 months. Scar formation was minimal, and the thoracic cage was preserved. Conclusion: The feasibility of thoracoscopic repair of EA has already been demonstrated. Today, its results in terms of operating time, feeding, hospital stay, and postoperative complications are equal to open procedures. Its advantages include better cosmesis and preservation of the thorax.