Poster - 44
Right-sided thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: feasibility and outcomes in patients with accompanying congenital vascular anomalies
D Borselle, D Patkowski
Department of Pediatric Surgery and Urology, Medical University and Hospital in Wroclaw, Poland
Introduction: This study aims to analyze the occurrence of congenital vascular anomalies (CVAs) in patients with esophageal atresia and tracheoesophageal fistula (EA/TEF), assessing their impact on clinical presentation, surgical management, and outcomes.
Methods: A retrospective review of type C or D EA/TEF patients treated between 2005 and 2023 was conducted. Demographics, clinical characteristics, CVA presence and type, associated major cardiac defects, surgical treatment and outcomes were compared.
Results: Among 161 patients with type C or D EA/TEF we identified 22 patients (13.7%) with congenital vascular anomalies (CVAs), including: right aortic arch–11/161 (6.8%), hypoplastic/absent azygos vein–8/161 (5%), additional aortic arch vessel–3/161 (1.9%), aortic coarctation–2/161 (1.2%), persistent left superior vena cava–2/161 (1.2%). Patients with CVAs had a significantly higher prevalence of associated anomalies (16/22, 72.7%), particularly major cardiac defects (8/22, 36.4%). The entire population underwent a preoperative echocardiography. All consecutive patients were treated only thoracoscopically as primary esophageal anastomosis. Right-sided thoracoscopic approach was performed in all newborns except for two cases (situs inversus with hypoplastic right chest cavity and right lung agenesis). There was no surgery-related mortality. Early mortality in patients with CVAs was related to more frequent associated malformations. Anastomotic leakage concerned 4/22 (18.2%) patients and was treated conservatively in all cases. There was no recurrent TEF among the analyzed population. Native esophagus was preserved in all patients.
Conclusions: Right-sided thoracoscopic approach for EA/TEF patients with congenital vascular anomalies is feasible. This approach enables safe esophageal anastomosis. Preoperative diagnostic imaging did not influence the choice of surgical approach. Right aortic arch should not be considered a contraindication to right-sided thoracoscopy.