Thoracoscopic repair of H-type tracheoesophageal fistula (TEF) in a newborn

A tracheoesophageal fistula (TEF) is a congenital or acquired communication between the trachea and esophagus. TEFs often lead to severe and fatal pulmonary complications. Most patients with TEFs are diagnosed immediately following birth or during infancy. TEFs are often associated with life-threatening complications, so they are usually diagnosed in the neonatal period. It is evidenced by fiber endoscopy or contrast swallow and esogastroduodenal contrast exam. Surgery for treatment of this malformation benefits from thoracoscopy as shown in this video.

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Thoracoscopic repair of H-type tracheoesophageal fistula (TEF) in a newborn

Authors

Abstract

A tracheoesophageal fistula (TEF) is a congenital or acquired communication between the trachea and esophagus. TEFs often lead to severe and fatal pulmonary complications. Most patients with TEFs are diagnosed immediately following birth or during infancy. TEFs are often associated with life-threatening complications, so they are usually diagnosed in the neonatal period. It is evidenced by fiber endoscopy or contrast swallow and esogastroduodenal contrast exam. Surgery for treatment of this malformation benefits from thoracoscopy as shown in this video.

Catégorie

complex cases

Mots-clés

Thoracoscopic repair, H-type tracheoesophageal fistula, TEF, newborn, pediatrics

Type de vidéo

Vidéo chirurgicale

Durée

03'44''

Publication

2009-05

Popularité

Favoris

Favorites Media

Audio

Sous-titres

E-publication

WeBSurg.com, May 2009;9(05).
URL: http://www.websurg.com/doi-vd01en2641.htm

Thoracoscopic repair of H-type tracheoesophageal fistula (TEF) in a newborn

1. Introduction 00'03''

H-type fistula is a congenital malformation of the esophagus, which manifests itself by choking episodes or feeding difficulties. Such choking episodes are induced by this type of fistula. It is evidenced by fiber endoscopy or contrast swallow and esogastroduodenal contrast exam. Surgery for treatment of this malformation benefited from thoracoscopy as shown here. Exposure allows to easily reach the site of the fistula.

2. Identification of the fistula 00'56''

We are superior to the azygos vein and you can see here that using compression exerted by the hook, we can identify the fistula. It is located at the superior third of the esophagus.

3. Dissection 01'10''

Dissection starts above the arch formed by the azygos vein. The dissection is performed between the esophagus and the trachea. As can be seen here, the vagus nerve helps us as a guide for the dissection. A pneumoperitoneum (with a pressure of 8mm Hg) allows us to improve the exposure. Here the fistula is fairly well delimited. Some experts use a guide wire endoscopically in order to localize this fistula. Though we do not use it here, we could localize the fistula site perfectly well in order to divide it.

4. Closure of the fistula 02'06''

It is sutured by interrupted stitches (Vicryl 5/0). Once the fistula has been perfectly sutured and proves patent, the esophagus is freed. We get a perfect view in this type of malformation that would have required an upper thoracotomy or a thoracotomy combined with a cervicotomy. The suture of the esophageal portion is achieved through 1 or 2 stitches; here the mucosal stitch is completed with a muscular stitch.

5. Patency control 03'25''

Control of the patency is achieved and marks the end of the procedure.