Thoracoscopic elongation of the esophagus in long gap esophageal atresia

Abstract

Long gap esophageal atresia in which a primary anastomosis cannot be achieved remains a challenge. Elongation of the esophagus by traction on the 2 ends has been previously described. With the advent of thoracoscopic repair of esophageal atresia, there have thus far been no reports of thoracoscopic repair of long gap esophageal atresia. This paper describes the first successful repair of long gap esophageal atresia by thoracoscopic traction of the 2 esophageal ends and delayed thoracoscopic anastomosis.

Minimal invasive surgery in the newborn: Current status and evidence

“…One is the use of mechanical traction to accelerate the growth of the esophageal ends and allow earlier primary anastomosis. 96,97 With the introduction of thoracoscopic repair of esophageal atresia, van der Zee et al 98 recently described the repair of long-gap esophageal atresia by thoracoscopic traction of the two esophageal ends and delayed thoracoscopic anastomosis.…”

Esophageal replacement in children: Challenges and long-term outcomes

“…This technique has a high risk of infection, disruption of the esophageal ends, risk of anastomotic stricture (70%), anastomotic leak (50%), severe gastroesophageal reflux (60%), and requires multiple thoracotomies with its associated risks. [ 8 9 10 ]…”

Anaesthesia for oesophageal atresia with or without tracheo-oesophageal atresia

“…Thoracoscopic repair of a TOF or oesophageal atresia poses an added challenge to the anaesthesiologist's ventilation management by adding gas insufflations to lung collapse. [18][19][20][21][22][23][24] Long gap oeosophageal atresia often cannot be corrected in the first operation and necessitates staged operations. It is sometimes necessary to use alternative tissue transplants to close the gap.…”

“…Thoracoscopic surgery, although superior in view of its lesser postoperative complications, such as pain and neuromuscular disorders, necessitates the use of gas insufflation and lung collapse via a transpleural approach. [18][19][20][21][22][23][24] This method can complicate ventilation in the already difficult-to-ventilate patient. The extrapleural approach would then seem to be a better option in such cases.…”