IPEG 2018 - RIGHT THORACOSCOPIC REPAIR OF AN H-TYPE TRACHEOESOPHAGEAL FISTULA

H-type TEFs are very rare and represent about 4% of all TEFs

H-type TEFs are usually diagnosed later in infancy when the patient presents with difficulty swallowing, aspiration, and recurrent pneumonias

The procedure was performed using 3 ports: a camera port behind the tip of the scapula at approximately the 4th intercostal space, a working port directly below the camera port, and another one anterior to it at the mid-axillary line

The parietal pleura at the groove of the esophagus and the trachea was opened using a combination of blunt dissection and a bipolar energy device

A 5 millimeter stapler was used to transect the tracheoesophageal fistula

A pleural flap was placed between the staple lines to help avoid a recurrent fistula

The patient had a swallow study on post-op day 2 that was negative for a leak

Advantages to a thoracoscopic H-type TEF repair are direct and magnified visualization between the esophagus and the trachea

Thoracoscopic approach allows visualization of the vagus nerve and avoidance of injury to the recurrent laryngeal nerve

Thoracoscopic approach avoids a neck incision