209 Two-Stage Thoracoscopic Repair of Long Gap Oesophageal Atresia with Right sided aortic arch Using an Internal Traction Technique (ITT)
Ahmed Suleiman1, Munther Haddad2, Amulya Saxena1, Simon Clarke3
1Chelsea Children's Hospital, London, United Kingdom. 2chelsea children's hospital, london, United Kingdom. 3Chelsea Children's Hospital, london, United Kingdom


Introduction: Management of long gap oesophageal atresia (OA) poses many challenges to the paediatric surgeon and often results in lengthy inpatient stays for the patient. Traction techniques are being increasingly reported in an attempt to address this. Presence of a right sided aortic arch can add to the technical difficulty paediatric surgeons face.

 Aim:  To share our experience in managing a case of long gap oesophageal atresia with a right-sided aortic arch (RAA)using a Two-Stage Thoracoscopic Internal Traction Technique(ITT).

Methods: A  2.5 kg  neonate with a prenatal diagnosis of OA and a RAA underwent a first stage thoracoscopic ITT at day 8 of life.  The gap length was estimated at 5 vertebral bodies before stretching. Two traction sutures of 4-0 ethibond were used after adequate mobilization of both ends. EndoClips were applied to maintain the stitch traction and to allow radiological progress post operatively. No gastrostomy was fashioned. A successful second stage thoracoscopic tension repair took place 10 days later.

Results: Following the tension repair ,the patient was ventilated and paralyzed for 5 days. Tube feeding was initiated on day 6 post-operatively  and progressed to full feeds within 5 days.  An oral contrast study was done on day 15 post op which confirmed a sound anastomosis with no leak or hold up.  Bottle feeds were initiated and the patient was discharged surgically aged 7 weeks old.

Conclusion: Two-stage Thoracoscopic repair of long gap OA with a right sided aortic arch using internal traction is feasible and may significantly reduce in patient stay . The video demonstrates the improved view the operator is afforded compared to the open technique, as well as the delicate dissection required around the aorta.