Abstract
Herein we report a case of long gap esophageal atresia without tracheoesophageal fistula in which thoracoscopic repair was performed following multi-staged extrathoracic esophageal elongation. A baby girl was born at 30 gestational weeks, and her birth weight was 1,146g. Cervical esophagostomy was made at 3 months of age because of the long gap (5 vertebral bodies). After two extrathoracic esophageal elongations, thoracoscopic repair of esophageal atresia was performed at 10 months of age. After being freed from the anterior chest wall, the proximal esophagus was brought into the right chest through the upper part of the posterior mediastinum under thoracoscopic guidance. A total of 4 ports were placed again in the right chest. The distal esophagus was found at the posterior mediastinum just above the diaphragm. Thoracoscopic esophageal reconstruction was performed by interrupted one-layer anastomosis with 5-0 monofilament absorbable sutures. Anastomotic leakage occurred, and was managed conservatively. Oral feeding was started 3 weeks after the operation. Balloon dilatation was required three times to manage the anastomotic stricture, and laparoscopic antireflux surgery was required to manage GER. Thoracoscopic repair of the esophagus following multi-staged extrathoracic esophageal elongation, which does not require thoracotomy, could be a minimally invasive treatment strategy for infants with long gap esophageal atresia.
