Thoracoscopic Congenital Esophageal Stenosis Repair and Thal Fundoplication by Right Thoracic Approach: A Case Report.

Introduction: Congenital esophageal stenosis (CES) is a rare clinical condition found in 1 in 25000-50000 live births. Surgical treatment is required when endoscopic balloon dilatation is ineffective. Laparoscopic and thoracoscopic approaches are selected based on lesion location. Gastroesophageal reflux (GER) is often observed as a postoperative complication that necessitates additional fundoplication. We report a case of CES in the lower third of the esophagus that was treated with simultaneous thoracoscopic resection and Thal fundoplication using the right thoracic approach.

Case presentation: The patient was a 6-month-old boy who presented with vomiting after consuming solid food. Although he had been previously treated by a physician, he was referred to our hospital for further examination because of persistent symptoms at 1 year and 7 months of age. As his oral intake was insufficient, he was thin compared with his twin brother. On esophagography, an abruptly narrowing lesion was found at the Th9-10 level, and congenital esophageal stenosis was diagnosed. Since balloon dilatation under upper gastrointestinal endoscopy was ineffective, the patient was treated surgically. Thoracoscopic esophagectomy (end-to-end anastomosis) and fundoplication (Thal procedure) were simultaneously performed via the right thoracic cavity. Although transient postoperative gastric paresis due to vagus nerve injury was observed, the patient improved with medical treatment and was discharged on postoperative day 14. He is currently able to ingest solid food orally, without GER.

Conclusions: CES can be a surgical indication for a thoracoscopic approach, depending on the site of the lesion. This is the first case in which anti-reflux surgery was performed simultaneously with thoracoscopic CES repair. We consider that this technique is useful for preventing not only GER, but also anastomotic leakage.