Adv Pediatr Surg.  2019 Jun;25(1):24-28. 10.13029/aps.2019.25.1.24.

Successful Correction of Long Gap Esophageal Atresia with Gastric Tube through Totally Laparoscopic and Thoracoscopic Procedure

• Yang HB
• Kim HY
• Jung SE

• KMID: 2451065
• DOI: http://doi.org/10.13029/aps.2019.25.1.24

Abstract

Esophageal atresia (EA) is a diverse disease entity. We present a case of long gap EA without fistula corrected through totally laparoscopic and thoracoscopic esophageal replacement using gastric tube. A male baby weighing 3,000 g, with suspicion of EA, was born at gestational age of 37+6 weeks. Gastrostomy was made at an age of two days; seven months later, definite operation was planned. We determined to perform the gastric tube replacement due to long gap revealed by fluoroscopy. Gastric mobilization, gastric tube formation, and pyloroplasty were performed laparoscopically. An isoperistaltic 9 cm gastric tube was made using 2 Endo GIA 45, and interrupted end-to-end esophago-esophagostomy was performed thoracoscopically. With laparoscopy, gastropexy to the diaphragm was performed through the interrupted suture. Operation time was 370 minutes; there was no intraoperative event. Postoperative course was uneventful. He underwent esophageal balloon dilatation due to anastomosis stenosis in the months after surgery.

Keyword

Esophageal atresia; Laparoscopy; Thoracoscopy; Minimally invasive surgical procedures

MeSH Terms

Constriction, Pathologic
Diaphragm
Dilatation
Esophageal Atresia*
Fistula
Fluoroscopy
Gastropexy
Gastrostomy
Gestational Age
Humans
Laparoscopy
Male
Minimally Invasive Surgical Procedures
Sutures
Thoracoscopy

Figure

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  Fig. 1 Fluoroscopy at the age of 7 months. Rudimentary distal esophagus, 6 vertebrae gap, distance from proximal to distal atresia: 8 cm.

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  Fig. 2 Port location for (A) laparoscopic procedure and (B) thoracoscopic procedure.

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  Fig. 3 Isoperistaltic gastric tube formation using 2 Endo GIA 45 (Covidien, Mansfield, MA, USA) along with greater curvature. Hand sewn end-to-end anastomosis, interrupted 5-0 Vicryl suture. (A) Gastric tube (stapler line annotated), (B) Proximal esophagus, (C) Diagram before reconstruction, and (D) Final position of stomach, diaphragm, and esophagus.

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