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Oral Presentation - 45
Staged Thoracoscopic Internal Traction Approach for Repair of Long Gap Esophageal Atresia with Distal Tracheoesophageal Fistula
C Gigena Heitsman*, N Sajankila*, A DeRoss*, M Lopez*, M Maricic**, M Guelfand*
*Cleveland Clinic
**Elizalde's Hospital
Introduction:
Long-gap esophageal atresia (LGEA) poses significant challenges for primary esophageal anastomosis, particularly in cases with or without tracheoesophageal fistula (TEF). This series evaluates a novel, staged thoracoscopic internal traction approach to reduce anastomotic tension during repair of LGEA with distal TEF.
Methods:
A retrospective review (2018–2022) was conducted across three tertiary centers to identify patients with LGEA and distal TEF managed with staged internal traction. The procedure began with rigid bronchoscopy, followed by thoracoscopic ligation of the tracheoesophageal fistula and inferior dissection of the distal esophagus. The proximal esophageal pouch was mobilized superiorly, and internal traction sutures were employed when direct anastomosis was deemed unsafe or excessively tensioned. Definitive primary anastomosis was performed after a short interval.
Results:
Seven patients underwent this approach. Median gestational age was 34 weeks, with a mean birth weight of 1997.1 ± 626.4 g. The average age at initial surgery was 2.3 ± 1.0 days, and definitive anastomosis occurred at 15.9 ± 13.2 days. No cases of anastomotic leak or esophageal dehiscence were reported. Three patients required esophageal dilations, and six required treatment for gastroesophageal reflux (GERD).
Conclusion:
Staged thoracoscopic internal traction is a minimally invasive, effective technique for LGEA with distal TEF, enabling safe repair under reduced tension and minimizing complications associated with traditional long-gap anastomotic techniques.