Objective: Repair of esophageal atresia and tracheoesophageal fistula has traditionally been performed
via thoracotomy. This study aims to evaluate the feasibility and pitfalls of the thoracoscopic
approach.
Materials and Methods: Six consecutive patients with type C tracheoesophageal fistulae underwent
thoracoscopic repair. The operation was approached through the right chest using a threetrocar
technique (two 5-mm and one 3-mm) with the patient placed in a three-quarter prone position.
Patient characteristics, operative time, duration of narcotic usage, conversion factors,
postoperative complications, and long-term follow-up were recorded.
Results: Five of six patients were successfully operated on thoracoscopically. The average operative
time was 143 minutes (range, 75–215 minutes) with repair of long-gap defects requiring significantly
longer times than short-gap defects (200 vs. 129 minutes, P < 0.05). There were no intraoperative
complications. Mean duration of narcotic use was 52 hours (range, 24–72 hours). There were
no anastomotic leaks. One patient developed an anastomotic stricture at the third postoperative
week, which resolved with two dilations. One patient died on the first postoperative day from respiratory
failure.
Conclusion: Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula is feasible,
but is technically challenging. Long-gap defects require more extensive dissection and difficult anastomosis,
and are therefore associated with longer operative times. More data are needed for further
evaluation of this approach.
