Thoracoscopic Tracheoesophageal Fistula and Esophageal Atresia Repair

Thoracoscopic repair is indicated for tracheoesophageal fistula (TEF) and esophageal atresia (EA) if the infant is hemodynamically stable, the anesthesiologist is comfortable with management of chest insufflation, and the surgeon is experienced in working efficiently in a small space. Thoracoscopy allows for rapid identification of the TEF for ligation, minimizing acute gastric dilation due to prolonged ventilation of the fistula. Although absolute lower weight limits for thoracoscopic repair have not been established, significant prematurity and birth weight <2000 g should probably only be attempted by experts. Other relative contraindications include severe congenital heart defects and significant abdominal distension that preclude single-lung ventilation and chest insufflation [1]. Compared to open TEF and EA repair, the thoracoscopic approach has similar rates of leaks and strictures, prolonged operative time, shorter time to extubation and initiation of feeds, and reduced length of stay [2].