Abstract
We present the first nine neonates with esophageal atresia and distal tracheoesophageal fistula (TEF) treated by the authors with a primary thoracoscopic repair.
To close the fistula and create the esophageal anastomosis, a three-trocar approach with carbon dioxide insufflation is required.
Primary correction was accomplished in all cases. No operative complications were encountered. The mean operative time was 105 minutes (range, 70-189 minutes). Three patients (33%) developed anastomotic stricture that required periodic balloon dilation; results were good. Two patients (22%) developed anastomotic leak; one case was mild and secondary to gastric perforation. The cosmetic results were significantly better than those observed after open thoracotomy.
Although thoracoscopic primary repair of TEF appears to offer considerable advantages, further experience and a larger number of cases are required to advance the learning curve; thus, at this stage, the rates of stricture and leakage seem to be higher than those observed historically.
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