title: Thoracoscopic repair of esophageal atresia with a distal fistula - lessons from the first 10 operations.
abstract: BACKGROUND
  Thoracoscopic esophageal atresia (EA) repair was first performed in 1999, but still the technique is treated as one of the most complex pediatric surgical procedures.
  
  
  OBJECTIVE
  The study presents a single-center experience and learning curve of thoracoscopic repair of esophageal atresia and tracheo-esophageal (distal) fistula.
  
  
  METHODS
  From 2012 to 2014, 10 consecutive patients with esophageal atresia and tracheo-esophageal fistula were treated thoracoscopically in our center. There were 8 girls and 2 boys. Mean gestational age was 36.5 weeks and mean weight was 2230 g. Four children had associated anomalies. The surgery was performed after stabilization of the patient between the first and fourth day after birth. Five patients required intubation before surgery for respiratory distress. Bronchoscopy was not performed before the operation.
  
  
  RESULTS
  In 8 patients, the endoscopic approach was successfully used thoracoscopically, while in 2 patients conversion to an open thoracotomy was necessary. In all patients except 1, the anastomosis was patent, with no evidence of leak. One patient demonstrated a leak, which did not resolve spontaneously, necessitating surgical repair. In long-term follow-up, 1 patient required esophageal dilatation of the anastomosis. All patients are on full oral feeding.
  
  
  CONCLUSIONS
  The endoscopic approach is the method of choice for the treatment of esophageal atresia in our center because of excellent visualization and precise atraumatic preparation even in neonates below a weight of 2000 g.
authors.affiliation: Department of Pediatric Surgery and Traumatology, University of Lublin, Lublin, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Nachulewicz
authors.affiliation: Department of Pediatric Surgery and Traumatology, University of Lublin, Lublin, Poland.
authors.forename: Kamila
authors.initials: K
authors.lastname: Zaborowska
authors.affiliation: Department of Pediatric Surgery and Traumatology, University of Lublin, Lublin, Poland.
authors.forename: Błażej
authors.initials: B
authors.lastname: Rogowski
authors.affiliation: Department of Pediatric Surgery and Traumatology, University of Lublin, Lublin, Poland.
authors.forename: Anita
authors.initials: A
authors.lastname: Kalińska
authors.affiliation: Department of Pediatric Surgery and Traumatology, University of Lublin, Lublin, Poland.
authors.forename: Marzena
authors.initials: M
authors.lastname: Nosek
authors.affiliation: Department of Pediatric Surgery and Traumatology, University of Lublin, Lublin, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Golonka
authors.affiliation: Department of Intensive Care Unit, University of Lublin, Lublin, Poland.
authors.forename: Witold
authors.initials: W
authors.lastname: Lesiuk
authors.affiliation: Department of Pediatric Surgery and Traumatology, University of Lublin, Lublin, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Obel
keywords: distal esophageal fistula; esophageal atresia; videothoracoscopy