Thoracoscopic repair of congenital esophageal atresia in neonates: a report of 69 cases

Objective To evaluate our experiences in thoracoscopic repair of congenital esophageal atresia with tracheoesophageal fistula (EATEF) in neonates.Methods The 3-trocar thoracoscopic procedures of esophageal anastomosis and fistula ligation were performed for 69 neonates from January 2010 to January 2014.There were 42 males and 27 females with an age range of 1-48 days and a body weight of 1.4-3.5 kg.In all cases,the diagnosis was made based on esophageal radiological contrast plus echocardiography and abdominal ultrasonography.At the end of procedure,a chest tube was implanted.Results A total of 69 patients underwent thoracoscopic repair.And 63 had one-stage repair successfully.Two operations were converted into open thoracotomy and 4 cases had to be staged due to a long gap between 2 esophageal segments.The average operative duration was 123-± 39 (73-205)min.The amount of bleeding was ＜10 ml except for 40 ml in one case.The mean length of mechani cal ventilation was (2.7 ± 2.3) days.Nine cases had anastomotic leak.The follow-up period was 2-45 months.And 25 neonates developed anastomotic stricture and required esophageal dilatation 1 to 18 times.Recurrent fistula between esophagus and trachea developed in 4 cases.Later one case required laparoscopic fundoplication.And six cases died.Conclusions The thoracoscopic procedure is both safe and effective in the treatment of EATEF.Initial attempts result in a higher incidence of such complications as stricture and leak.Better outcomes may be achieved with technique refinements. Key words: Thoracoscopy;  Esophageal atresia;  Tracheoesophageal fistula