title: Thoracoscopic repair of tracheoesophageal fistula and esophageal atresia.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of the thoracoscopic repair of esophageal atresia and tracheoesophageal fistula (EA/TEF).
  
  
  METHODS
  From August 2005 to March 2008, 23 consecutive patients (16 boys, 7 girls) weighing 1,070 to 3,390 g underwent thoracoscopic EA/TEF repair. Nine cases had associated malformations. Two 5-mm and one 2.5-mm trocars were placed. The 5-mm 25- to 30-degree telescope was preferred. A pneumothorax was maintained with 5 to 6 mm Hg. The azygos vein was never divided. The TEF was closed with 5-mm titanic clips mainly.The esophageal anastomosis was made over 6-French nasogastric tube by three to seven simple stitches of 5-0Vicryl. The 8-French chest tube was left without suction. The enteral feeding was usually started on postoperative day 3 or 4. Barium swallow was performed on postoperative day 5 or 6, then the chest tube was removed.
  
  
  RESULTS
  All procedures were successfully completed without conversion. The average operative time was 131 minutes (range, 55-245 minutes) with significant improvement after gaining experience (mean, 171 minutes for first 10 cases and 98 minutes for last 13 cases). There were two cases of accidental tracheal opening. The anastomotic leak rate was 13% (three cases), and all were healed on conservative treatment. Four cases required one to three courses of anastomotic stricture dilatations. There were three deaths (13%) of causes not related with performed operation.
  
  
  CONCLUSIONS
  The thoracoscopic repair of EA/TEF is effective method, and based on our experience, it is the procedure of choice if performed by an experienced endoscopic pediatric surgeon. The intraoperative complications observed if properly managed have a good prognosis.
authors.affiliation: Department of Paediatric Surgery and Urology, Medical University of Wroclaw,Wroclaw, Poland. dpat@chdz.am.wroc.pl
authors.forename: Dariusz
authors.initials: D
authors.lastname: Patkowsk
authors.forename: Konrad
authors.initials: K
authors.lastname: Rysiakiewicz
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jaworski
authors.forename: Marzena
authors.initials: M
authors.lastname: Zielinska
authors.forename: Grazyna
authors.initials: G
authors.lastname: Siejka
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Konsur
authors.forename: Jerzy
authors.initials: J
authors.lastname: Czernik
mesh_terms: D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007431:Intraoperative Complications; D008297:Male; D013906:Thoracoscopy / Q000379:methods*; D014138:Tracheoesophageal Fistula / Q000601:surgery*