IPEG 2020 TOP ABSTRACT: Laparoscopic Treatment of Esophageal Obstruction Caused by Embryonic Remmants

Laparoscopic treatment of congenital trachi bronchial cartilage remnants of esophagus. This is a rare congenital pathology of the esophagus and the first report was in 1936. This should be distinguished from reflux stenosis, alasia, and other congenital diseases of the esophagus. We intend to show our experience in the laparoscopic treatment of this pathology. We treated for patients aged 18 to 13 months which presented vomiting and dysphagia, cough, or bronchospasm. The contrasted study showed in all cases an obstruction in the lower third of the esophagus above the esophagogastric junction. Endoscopy showed an obstruction in the distal part of the esophagus with a compression effect as we can see in this study. In other cases, the presence of food debris that when removed shows an off-white whitish ring. Through a four-part laparoscopic approach, a wide dissection of the esophagus was performed, releasing the frenoesophageal membrane. The endoscope was introduced to limit the diseased area of the esophagus, appreciating in a white lesion, as well as a change of caliber that we can see better when we remove the endoscope. Here the normal esophagus dilated above the diseased site can be seen with the white image already commented. Two silk fixation stitches are placed on each side of the esophagus towards the pillars of the diaphragm to avoid retraction of the organ when resecting the diseased segment. The vagus nerve and its branches are separated to preserve them and avoid injury at the time of resection. Once the diseased segment was identified, the esophagus was cut in the anterior aspect until we can see the intraluminal tube. We continued cutting the lateral aspect of the esophagus until it was separated from the distal healthy lower portion. The site where the healthy esophagus should be cut is identified and is cut gradually, taking care not to damage the nervous structures that we can see. Until a complete resection of the affected segment is achieved. The affected segment is removed, and the suture to the pillars prevents retraction towards the thorax. And anastomosis with 2 au polyester in one plane with separate sutures is carried out starting at the back. To continue with total suture of the same material in the anterior part of the anastomosis as we can see here. Placing several sutures until the front face of the anastomosis is closed. The permeability of the anastomosis is verified, passing the endoscope to the distal part without appreciating leakage of the anastomosis with water irrigation and air insufflation. Next, a pillarplasty and a funduplication are performed and placed on the anastomosis. This is the aspect at the end of the operation. Surgical time was 3 hours without convulsions or complications. The histopathological studies showed the presence of an intramural cartilaginous ring in all patients. An esophagram was performed 5 days after surgery with adequate passage to stomach without leaks in 3. There was an occurrence of a patient leaked from the anastomosis, but currently all patients are able to orally feed. Controlled endoscopy after a year showed in all cases an adequate esophageal lumen. In these patients, resection of the affected segment is a treatment of choice, and this can be done using laparoscopy.