IPEG 2020 TOP ABSTRACT: Clip & Go Technique for thoracoscopic repair of H-type tracheoesophageal fistula.

Clip and go technique for trachoscopic repair of H-type tracheesophageal fistula. H-type tracheesophageal fistula is a rare disease and thrachoscopic treatment has been described. The aim of this work is to introduce the clip and go technique. One month old male patient were referred to our center presenting cyanosis crisis, choking and cough associated with feeding. It has a contrast swallowing X-ray compatible with H-type tracheesophageal fistula. We decide to perform a respiratory endoscopy and confirm the diagnosis by identifying the fistula on the posterior face of the trachea, a few centimeters above the carina. Under direct visualization, we pass a wire through the fistula to facilitate its identification during surgery. Patients and ports were placed in a similar way as a classic esophageal attrition, moving the left port nearer to the spine. We start dissecting the posterior metastinum using blunt maneuvers and cautery in order to identify the esophagus and the trachea. The fistula is easily found by filling the wire inside. Dissection of both sides and the posterior aspect of the fistula is carried out. Then a 306 suture is passed behind. The wire is pulled out and the fistula is closed. We use another 30 silk suture right next to the first one. And a 5 millimeter envelope clip is added in the airway side without sectioning the fistula. There were no intra or postoperative complications, oral feeding was well tolerated, and the follow up was 18 months and remains asymptomatic. In this case, clip and go technique results to be safe, effective and reproducible for the tarchoscopic treatment of H-type tracheesophageal fistula. Thank you very much.