2017 Volume 53 Issue 5 Pages 1037-1041
We report a case of successfully operated Gross C esophageal atresia by a transcervical approach following preoperative examinations. A 2,080 g baby girl of 37 weeks 2 days’ gestation was delivered. She was the second of twin fetuses. Hypoplasia of the right lung was detected during the gestation. No hydramnios was detected. We were unable to pass a nasogastric tube through the esophagus, and the X-ray result showed the coil-up sign with a gastric bubble. She was diagnosed as having esophageal atresia with distal tracheoesophageal fistula (TEF) and right pulmonary hypoplasia. We planned a radical operation after assessing her respiratory condition and evaluating her anatomical bronchial form. Bronchoscopic examination was performed before gastrostomy at 0 days of age. The distal TEF was identified 13 mm above the carina. Contrast chest CT showed that the upper pouch of the esophagus and the distal TEF were at the level of the second thoracic vertebra. On the basis of preoperative examinations, we chose the transcervical approach to repair the esophageal atresia and distal TEF at 5 days of age. A 3 cm transverse incision was made 1 cm above the left clavicle. The end of the upper pouch and the distal TEF were almost at the same positions. The division and closure of the TEF and esophago-esophageal anastomosis were performed successfully. The postoperative course was uneventful. Preoperative bronchoscopy and CT are useful for determining the type of esophageal atresia and for deciding the surgical approach.
