Thoracoscopic Approach in Recurrent Tracheoesophageal Fistula

Abstract

Introduction:

Recurrent fistulization after tracheoesophageal fistula (TEF) repair can be a complication of difficult management. There are few data on thoracoscopic reintervention. ^1,2 The authors present a video of a thoracoscopic approach in a recurrent fistula after TEF repair by thoracotomy.

Material and Methods:

A child with 20 months of life was found with a recurrent fistula by bronchoscopy. The patient had a history of recurrent respiratory symptoms after a surgical correction of esophageal atresia with TEF by thoracotomy. A right-sided thoracotomy was performed; three trocars were used (two 5 mm and one 3 mm). Right upper lobe adhesions from a previous surgery were divided with electrocautery. The azygos vein was identified and preserved. The TEF was identified just above the azygos vein, dissected, and isolated; two titanium clips were applied and the fistula was then divided. The clips were reinforced with endoloops^®. A prolene^® mesh was interposed between the trachea and the esophagus. There were no postoperative complications. The nasogastric tube was removed in the first postoperative day and the child was discharged in the second day after starting oral feeding. Currently, the child is followed up in the outpatient clinic and he is otherwise healthy.

Conclusion:

It is possible to apply the thoracoscopic approach in the treatment of recurrent fistulization after TEF repair. ^{3 –5}

No competing financial interests exist.

Runtime of video: 3 mins 54 secs

This video was accepted for presentation at IPEG Meeting 2014.