Posterior Tracheopexy during Primary Esophageal Atresia Repair
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Key Takeaways
- Posterior tracheopexy can be performed during primary thoracoscopic EA repair when bronchoscopy shows >2/3 posterior tracheal lumen occlusion.
- The technique adds only 6 minutes per suture (2-3 sutures total) to the primary repair without significant additional operative time.
- All four patients in this series had no postoperative respiratory symptoms, suggesting potential benefit of prophylactic intervention.
- Non-absorbable sutures are used to pex the posterior tracheal wall to the spinal ligament during the same thoracoscopic procedure.
- Preoperative bronchoscopy is essential to identify moderate-severe posterior membranous tracheomalacia warranting concurrent tracheopexy.
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This is Todd Ponsky from the Journal of Pediatric Surgery, and today we are in the Netherlands at the Dutch Annual Surgical Society meeting. We had a great opportunity while here to get a review, a 2-minute review on an article that was just published in the Journal of Pediatric Surgery on a very controversial topic about the posterior tracheopexy. We recently did a, uh, a review on posterior tracheopexy from Dr. Jennings group, and now there's a new twist to this. Uh, the using thoracoscopy and doing a posterior tracheopexy, uh, routinely when doing an esophageal atresia repair. With us today, we have Dr. Stephan Derhauf, and you can also pronounce this in English, Tippot, and he is going to be presenting a paper that they just published, uh, out of Utrecht. Esophageal atresia is a forger anomaly, so usually the trachea is also affected. Now, at the bronchoscopy, you can assess the site of the TE fistula, and also you can assess whether it's more anterior problem or a posterior problems. Um, if there is more than 2/3 lumen occlusion, especially from the posterior side, then you should consider doing it. Now, in this paper, we describe four patients we operated last year. They all had moderate severe tracheomalacia at bronchoscopy, especially posterior membranous intrusion of the lumen, and those patients were operated during Esotoric scopic esophagogia atresia surgery. We made a pexia of the posterior wall towards the spinal ligament, and then we anastomosis both ends. This is done with non-absorbable suturing. So all patients recovered well, and none of them had any respiratory symptoms after surgery. This technique only takes 6 minutes per suture, and two or three sutures are placed. So during the thoraco scopic procedure, it doesn't take much extra time to perform it. Okay. I just want to make sure I got the summary right, what's being described here is that because it is so prominent in patients with esophageal atresia, instead of having to go back a second time for those patients, you guys do it proactively every time you're going to do an esophageal atresia repair. I think this is, in my opinion, this is going to be a very hot topic, whether it's right or wrong. I don't have the answer to that, but it's certainly important topic to be addressing, and I'm glad I had the opportunity to interview you. Thanks for inviting us here, and uh, thanks for doing the review. Thanks for the opportunity.