Thoracoscopic Repair of an Isolated H-Type Tracheoesophageal Fistula (TEF) in a Newborn Using Trans-Fistula Guide Wire: A Surgical First

Thoracoscopic repair of esophageal atresia with or without tracheoesophageal fistula (TEF) has recently been described. Isolated, intrathoracic H-type congenital TEF are quite rare. These lesions can be technically challenging, primarily due to the difficulty in accurately identifying the fistula location. We report the first case of thoracoscopic repair of an isolated, congenital H-type intrathoracic TEF in a newborn, utilizing a trans-fistula guide wire technique. A full-term 4.5 kg male infant developed choking and coughing with oral feeds on the first day of life (DOL). A barium esophagogram performed on DOL 8 demonstrated a large intrathoracic TEF at approximately the T2–T3 vertebral level. On DOL 10, intraoperative bronchoscopy and esophagoscopy with guide wire placement allowed definitive localization of the TEF. A three-trocar technique was used via the right chest, in modified prone position with left mainstem intubation. Identification of the TEF was aided by gentle upward traction on the guide ...