The thoracoscopic approach to esophageal atresia with distal fistula

Abstract

Esophageal atresia has been classically approached through a posterolateral thoracotomy. The disadvantages of such a thoracotomy have been recognized for a long time, for example winged scapula, elevation or fixation of the shoulder, asymmetry of the chest wall, rib fusion, scoliosis, and breast and pectoral muscle maldevelopment (Cherup et al. 1986; Chetcuti et al. 1989; Durning et al. 1980; Emmel et al. 1996; Freeman and Walkden 1969; Jaureguizar 1985; Schier et al. 2001; Westfelt and Nordwall 1991). Moreover chronic pain after thoracic surgery, at least in adults, is a serious problem and has been reported in more than 50% of patients (Perttunen et al. 1999; Rogers and Duffy 2000). Pediatric surgeons have tried to avoid classic posterolateral thoracotomy. Brown (1952) made a vertical skin incision, detached the serratus anterior muscle, and opened the intercostal space. Soucy et al. (1991) introduced the muscle-sparing thoracotomy into pediatric surgery, while Bianchi et al. (1998) advocated transaxillary thoracotomy. More recently esophageal atresia has been approached in a thoracoscopically assisted way through a minithoracotomy (Robert and Hardy 1999), but true thoracoscopic correction was first reported in 1999 (Lobe et al. 1999). This child had an esophageal atresia without fistula. Thoracoscopic repair of an esophageal atresia with distal fistula was first reported by Rothenberg in 2000, while Bax and van der Zee published a first series of eight thoracoscopic repairs of esophageal atresia with distal fistula in 2002. In 2003 they published a series of 13 cases (van der Zee and Bax 2003). This chapter will only deal with the thoracoscopic repair of esophageal atresia with distal fistula. © Springer-Verlag Berlin Heidelberg 2008.