Aim of the Study: We report our preliminary experience using a mini-thoracotomy approach created through an incision placed very high in the axilla for repair of oesophageal atresia and distal tracheoesophageal fistula.
Methods: Single surgeon’s experience (May 2011 to December 2017) of 28 consecutive patients who underwent apical axillary mini-thoracotomy for type C oesophageal atresia. Access to the thorax was obtained via an L-shaped skin incision (initial 5 patients), which was subsequently converted to a skin crease incision. Outcome measures included appropriateness of the surgical approach for the intended operation, postoperative complications, functional and cosmetic outcomes.
Main Results: Median weight at operation was 2.73 Kg (range, 1.2-3.7). Surgical incision ranged 2 to 3.5 cm in length (median, 2.5). Adequate operative exposure was achieved in all patients. Primary esophageal anastomosis was accomplished in all patients, except 1 very-low-birth-weight premature successfully managed by staged repair. Median operative time was 175 minutes (range, 120-245). Overall, there were 2 (7%) clinical anastomotic leaks that resolved with conservative treatment, 7 (25%) patients required dilations, and 2 (7%) needed a Nissen fundoplication. Three patients experienced a superficial wound dehiscence, which healed by secondary intention with a mild scar retraction that resolved spontaneously with time. At a median postoperative follow-up of 28 months (range, 1-72), 7 (26%) of the 27 survivors have a mild asymmetry of the upper anterior chest wall, which will require a more reliable assessment at longer follow-up. Excellent cosmetic outcome was achieved in all patients, whose scars were barely noticeable and progressively moved higher up into the apex of the axilla.
Conclusion: Apical axillary mini-thoracotomy for repair of type C oesophageal atresia yields comparable technical success and potentially better outcomes to conventional thoracotomy. This miniature surgical approach, although demanding, rivals the thoracoscopic repair and deserves further investigation.