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Video Presentation - 3
Left-Sided Thoracoscopic Redo Esophageal Anastomosis for Intractable Post-EA Stricture: Experience at Cairo University
H Seleim*, A Wishahy**, B Magdy**, M Elsoudi**, M Elbarbary**
*Department of Pediatric Surgery, Tanta University Hospital, Tanta, Egypt
**Cairo University Faculty of Medicine, Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital, Egypt
Introduction: Redo surgeries for esophageal atresia (EA) are challenging due to adhesions within the pleural cavity, particularly when re-accessing the esophagus via the right side (1). This video illustrates the left-sided thoracoscopic approach for managing intractable post-EA esophageal stricture.
Patients and Methods: A male infant born on March 2, 2022, was diagnosed with EA/tracheoesophageal fistula (TEF, type C) and underwent right thoracoscopic primary repair on day 13 of life. Postoperatively, a minor anastomotic leak was managed conservatively, and the infant was discharged on full oral feeds after 25 days.
Subsequently, the patient experienced recurrent choking and aspiration, necessitating multiple admissions. Investigations revealed a tight anastomotic stricture, refractory to eight sessions of endoscopic dilation and mitomycin-C application. To support caloric intake, a feeding gastrostomy was laparoscopically inserted.
Surgical resection and redo esophageal anastomosis were indicated due to the stricture's persistence. Considering the likelihood of dense right thoracic adhesions, a left-sided thoracoscopic approach was chosen.
On March 7, 2023, the procedure was successfully performed under general inhalational anesthesia. The child was positioned prone, and four 5 mm ports were utilized. The optical port was inserted just below the tip of the scapula. The left working port was placed in the 3rd intercostal space along the mid-axillary line, while the right working port was positioned in the 6th intercostal space, midway between the posterior axillary line and the vertebral spine. The assistant port was located in the 8th intercostal space along the posterior axillary line.
A minor anastomotic leak, noted on postoperative day seven, was managed conservatively. The child was discharged after 36 days of hospitalization.
During follow-up, a single endoscopic dilation was required one-year post-discharge. At the latest follow-up in November 2024, the child remained well, with no evidence of recurrent stricture or gastroesophageal reflux disease (GERD) on esophagogram and endoscopy.
Results and Conclusions: The left-sided thoracoscopic approach provides a feasible option for managing resilient post-EA strictures. Further studies with larger case series are needed to establish its efficacy and safety definitively.