Thoracoscopic Repair of Congenital Esophageal Atresia in Infants

Purpose: The aim of this study was to introduce the recent development of the one-stage esophageal anastomosis by using thoracoscopic surgery to repair neonatal esophageal atresia in mainland China. Two successful cases at the Shanghai Children's Medical Center (SCMC; Shanghai, China) are discussed. Methods: In 2007, fistula ligation and the one-stage esophageal anastomosis were performed successfully at SCMC by thoracoscopy on 2 infants with congenital esophageal atresia. The 2 male infants with type IIIB esophageal atresia weighed 2.9 and 2.4 kg and were 4 days and 8 weeks old, respectively. Upon admission, 1 infant suffered from severe aspirated pneumonia and received the corrective surgery when the infant was recovered from the pneumonia. Results: We successfully operated on 2 infants by thoracoscopic procedures. One baby developed a stomal leak on day 3 after the operation. Using conservative management, it was completely healed 1 week later. On the postoperative day 11, he could drink without anastomotic stenosis and was subsequently discharged on the day 15 after the operation. The other baby was discharged 10 days after surgery. However, 1 month later, he was found to have anastomotic stenosis, but was relieved of it after two balloon dilations. Both of them had an adequate weight gain during the 9- and 15-month follow-up periods. In reviewing the Chinese medical literature, it indicates that there exist only two related articles reporting about 4 successful thoracoscopic esophageal anastomosis surgeries for congenital esophageal atresia. Conclusion: On the Chinese mainland, pediatric thoracoscopic and laparoscopic surgery were introduced at a comparatively late stage. However, this procedure has advanced rapidly in recent years. Surgeons have gained successful experience and technique in the one-stage esophageal anastomosis by thoracoscopic surgery to treat the neonate with esophageal atresia. The results are encouraging and positive.