Thoracoscopy for Esophageal Diverticula After Esophageal Atresia With Tracheo-Esophageal Fistula

Abstract

Background: Esophageal diverticulum (ED) is an extremely rare complication of congenital esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) surgery. We aimed to investigate feasible methods for the treatment of this rare complication.Methods: We retrospectively reviewed all patients with EA/TEF at Beijing Children's Hospital from January 2015 to September 2019. The clinicopathological features of patients with ED after EA/TEF surgery were recorded. Follow-up was routinely performed after surgery until December 2020.Results: Among 198 patients with EA/TEF, ED only occurred in four patients (2.02%; one male, three female). The four patients had varying complications after the initial operation, including anastomotic leakage (3/4), esophageal stenosis (3/4), and recurrence of TEF (1/4). The main clinical symptoms of ED included recurrent pneumonia (4/4), coughing (4/4), and dysphagia (3/4). All ED cases occurred near the esophageal anastomosis. Patients' age at the time of diverticulum repair was 6.6–16.8 months. All patients underwent thoracoscopic esophageal diverticulectomy (operation time: 1.5–3.5 h). Anastomotic leakage occurred in one patient and spontaneously healed after 2 weeks. The other three patients had no peri-operative complications. All patients were routinely followed up after surgery for 14–36 months. During the follow-up period, all patients could eat orally, had good growth and weight gain, and showed no ED recurrence or anastomotic leakage on esophagogram.Conclusions: ED is a rare complication after EA/TEF surgery and is a clear indication for diverticulectomy. During the midterm follow-up, thoracoscopic esophageal diverticulectomy was safe and effective for ED after EA/TEF surgery.

Diagnose and treatment for Type D congenital esophageal atresia with tracheoesophageal fistula

“…With the development of thoracoscopy technology, an increasing number of pediatric surgeons have started using the thoracoscopic approach to treat EA/TEF, which has the advantages of minimal invasiveness and adequate visualization 12,13,23–26 . However, studies on the surgical treatment of type D EA/TEF with a definite preoperative diagnosis are lacking 9–11 .…”

“…With the development of thoracoscopy technology, an increasing number of pediatric surgeons have started using the thoracoscopic approach to treat EA/TEF, which has the advantages of minimal invasiveness and adequate visualization. 12 , 13 , 23 , 24 , 25 , 26 However, studies on the surgical treatment of type D EA/TEF with a definite preoperative diagnosis are lacking. 9 , 10 , 11 Some researchers believe that for EA/TEF with a preoperative diagnosis of type C, proximal TEF should be highly suspected in cases when a large amount of gas leaks from the proximal esophagus during intraoperative esophageal anastomosis.…”

“…Relevant surgical steps can be found in our previously published studies. 12,13 Postoperative follow-up Follow-up was routinely performed after surgery. Routine esophageal radiography was performed 7 and 14 days postoperatively.…”

“…A free prevertebral fascia or muscle flap was placed between the fistula tracts to prevent recurrence. Relevant surgical steps can be found in our previously published studies 12,13 …”