TEF akron 2018

Part of Esophageal Atresia and Tracheoesophageal Fistula 20 items

Document · May 2026 · 1 min read

In brief

Dr. Rothenberg presents the evolution of thoracoscopic TEF/EA repair from 2000-2018, covering 145 cases. Key technical modifications include prone positioning with 30-degree elevation, CO2 insufflation without single-lung ventilation, and single-layer anastomosis technique, achieving low complication rates including 3.4% leak and 0.7% recurrent fistula.

Single-lung ventilation not required for thoracoscopic TEF repair—CO2 insufflation with valved trocars suffices despite transient desaturation
Modified prone positioning (right side elevated 30-40°) uses gravity for lung retraction and optimizes posterior mediastinal access
Single-layer anastomosis technique (back row intraluminal, front row extraluminal) yields 3.4% leak rate in 145 cases over 18 years
Stricture rate 14% and fundoplication rate 24% represent key long-term morbidities requiring surveillance post-repair
Recurrent fistula rate of 0.7% demonstrates durability of thoracoscopic clip ligation technique for TEF division

Written by the GCMD Library team from the document.

Dr. Steve Rothenberg

Surgical content by Dr. Steve Rothenberg — Thoracic Surgery

Full text

Thoracoscopic Repair of Esophageal Atresia and Tracheoesophageal FistulaEvolution of a TechniqueSteven S Rothenberg Chief of Pediatric SurgeryThe Rocky Mountain Hospital for Children

First Thoracoscopic TEF Repair 2000 3.2 kg male, isolated anomaly/IPEG AtlantaPed Endosurg Innov Tech. (4) 289-294. 2000

TEF Repair

TEF RepairFirst Reported Series J Pediatr Surg (37) 869-872; 2002

Lessons Learned

Anesthesia Single lung ventilation: Not required! (CO2 insufflation and valved trocars) Increase in PCO2 Increase TV & PIP All babies desaturate initially but recover in a few minutes as shunt diminishes

Room Set-up: Thoracoscopic TEF Repair Modified Lat Decubitus Head Monitor MonitorSurgeonAssist Nurse

Positioning Initially used left lateral decubitus position Modified positioning to prone with right side elevated 30 to 40 degrees Use gravity to retract lung Adequate access for trocars (3 ports) Scope placed to look down on posterior mediastinum

TEF Repair Place more prone then not!30 degree scope, more posterior looks down on instruments.

New Trocar Posi:on Left hand moreposterior

Steps of TEF Repair Divide Azygus vein Ligate and divide fistula (clip) Mobilize upper pouch Excise tip of pouch Single layer anastomosis 5-0 PDS or Vicryl Back row intra-luminal, Front row extra-luminal (single interrupted)

TEF Repair: Post-op Management Chest drain in all patients Contrast study day 4 or 5 Feeds started after contrast study

TEF Repair

Thoracoscopic TEF/EA 2000-2018 2000-2018 145 cases Anastomotic leak: 3.4% Recurrent fistula: 0.7% Anastomotic stricture: 14% Fundoplication: 24% Aortopexy: 1.5%

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