CASE SERIES OF THORACOSCOPIC TREATMENT OF CONGENITAL ISOLATED H-TYPE TRACHEOESOPHAGEAL FISTULAS IN INFANTS

Abstract

Isolated H-type tracheoesophageal fistula is a rare anomaly of the respiratory tract which accounts for 4% of all malformations of the trachea and esophagus. Authors report patients with this developmental anomaly who underwent fistula dissection by the same single surgeon and at different surgical facilities with particular emphasis on preoperative diagnosis and treatment. Thoracoscopic transsection of H-type tracheoesophageal fistula was performed by a single surgeon in 5 patients (3 boys and 2 girls) with R. Gross congenital isolated type E fistulas who were admitted at 2 to 12 weeks of age. The patients were in three surgical facilities located in the cities of Irkutsk and Tomsk (both - Russia), Tashkent (Republic of Uzbekistan). In the final part the methods of preoperative examination, the parameters of the surgical intervention and the results of postoperative observation are given. All 5 procedures were successfully performed thoracoscopically without conversion into open intervention. The duration of the surgical intervention varied from 45 to 135 minutes. The average intervention period was 78.0±35.8 minutes (median - 60.0 [52.5; 112.5] minutes). The mean duration of mechanical ventilation in this group was 33.6±10.0 hours (median - 36.0 [24.0; 42.0] hours) with the longest interval being 48 hours in a patient with pre-existing respiratory distress. The exact time range to complete oral nutrition has been well documented and ranged from 5 to 8 days. Esophageal and tracheal suture failure was not recorded in patients with H-type tracheoesophageal fistula. Two patients required Nissen surgery for hiatal hernia at 6 months and 1 year after initial H-type tracheoesophageal fistula ligation. All patients are currently on full oral nutrition. The follow-up period in this group ranged from 12 to 60 months. These patients showed no signs of recurrence of the fistula. Patients were evaluated for vocal cord paresis if clinical stridor was observed postoperatively. However, no recurrent nerve injury was found in any of the patients in this series of cases. Authors did not record signs of chest asymmetry, pterygoid scapula, laxity of the shoulder girdle or clinically significant scoliosis. Thoracoscopy allows direct visualization and dissection of an H-type tracheoesophageal fistula. Authors believe this technique allows achieving better mobilization of the posterior mediastinal organs than in thoracotomy, which probably expands the scope of thoracoscopic access in the treatment of this disease.