THORACOSCOPIC RESECTION OF CONGENITAL ESOPHAGEAL STRICTURE

Thanks for the opportunity to show our work today. This video demonstrates a thoracoscopic resection of a congenital esophageal stricture. The patient is an otherwise healthy 18 month old male who presented with vomiting and choking episodes after starting solid foods. His contrast esophagram revealed a fixed distal esophageal stricture. The absence of a mass or additional pathology was confirmed by MRI. The esophagus was approached via the right chest. Dissection began by dividing the inferior pleural attachments of the lower lobe. A 3 millimeter vessel sealing device was used. Blunt dissection revealed the esophagus, which is then dissected medially and laterally with a combination of blunt dissection and hook electrocautery. Once the esophagus was well visualized at the presumed level of the stricture, intraoperative simultaneous endoscopy was used to confirm its location. The esophagus was then encircled with a vessel loop facilitating further distal dissection. The distal esophagus was then controlled with an additional vessel loop and a vicral stitch. The esophagus was then partially divided proximal to the ring of the stricture. A vicral suture was passed through the chest wall, through the proximal esophagus, and then back through the chest wall as a retraction stitch. The proximal transaction was then completed. The distal end of the stricture was then partly divided and another retraction suture placed in a similar fashion. Once this transaction was completed. The specimen was removed and the anastomosis started at the posterior lateral corner using a fro vico suture. Note the laparoscopic tumble knot. The back row of sutures was then placed with the knots on the inside of the lumen. The vessel loops were removed. An NG tube was then advanced through the anastomosis into the distal esophagus and stomach. The anterior aspect of the anastomosis was then completed with the knots on the outside of the lumen. Postoperatively, the child recovered well. Specimen histopathology demonstrated multiple tissue types. The postoperative esophagram revealed a patent anastomosis without leak, and the diet was advanced. The child was now eating solid foods and fully recovered.