Thoracoscopic repair of esophageal atresia without fistula

Abstract

Neonates without tracheoesophageal fistula represent 57% of all patients with esophageal atresia (EA). Depending on different authors, we classify these patients as type A or type I EA. In most of these patients, because the esophageal segments are too far apart to allow primary anastomosis, the term "long gap" is universally accepted as a synonym for EA without fistula. Although this term represents most of the cases without fistula, occasionally in infants with EA and tracheoesophageal fistula, the upper pouch is high and the distance between upper and lower esophageal segments limits the ability to easily complete a tension-free, end-to-end esophagoesophagostomy. There is no precise definition of "long gap" because there are variations on the methods used for determining the gap length and tension. The term "long gap" should therefore be used in any type of EA in which the distance between both pouches impedes a primary anastomosis. Although in this chapter we will only describe the thoracoscopic treatment for patients with type A EA, the displayed techniques can be used as tools for the treatment of most of the "long gap" EA cases. © Springer-Verlag Berlin Heidelberg 2008.