Thoracoscopic Repair of an Isolated H-Type Tracheoesophageal Fistula (TEF) in a Newborn Using Trans-Fistula Guide Wire: A Surgical First

Abstract

Thoracoscopic repair of esophageal atresia with or without tracheoesophageal fistula (TEF) has recently been described. Isolated, intrathoracic H-type congenital TEF are quite rare. These lesions can be technically challenging, primarily due to the difficulty in accurately identifying the fistula location. We report the first case of thoracoscopic repair of an isolated, congenital H-type intrathoracic TEF in a newborn, utilizing a trans-fistula guide wire technique. A full-term 4.5 kg male infant developed choking and coughing with oral feeds on the first day of life (DOL). A barium esophagogram performed on DOL 8 demonstrated a large intrathoracic TEF at approximately the T2–T3 vertebral level. On DOL 10, intraoperative bronchoscopy and esophagoscopy with guide wire placement allowed definitive localization of the TEF. A three-trocar technique was used via the right chest, in modified prone position with left mainstem intubation. Identification of the TEF was aided by gentle upward traction on the guide wire. Following wire removal, the TEF was occluded with 5-mm clips and divided. A pleural flap was interposed. A chest drain was placed. The patient was extubated within five hours, fed on postoperative day (POD) 3 and off all pain medications by POD 4. The chest tube was removed on POD 6. He was discharged home on POD 9 without apparent complications. An esophagogram performed one month after surgery showed normal esophageal shape and function. In summary, a newborn male with isolated intrathoracic H-type TEF underwent successful thoracoscopic repair with minimal morbidity, rapid recovery, and prompt hospital discharge.