WOFAPS 2025 8th World Congress of Pediatric Surgery

RUBI MARTINEZ, Miguel Torres, ABEUD RUIZ

Regional Maternal and Child Hospital of Nuevo León

Introduction

Esophageal atresia may occur alone or as part of a syndrome. Its surgical repair, done via thoracotomy or thoracoscopy, carries risks such as anastomotic leaks (3-17%), stenosis (17-60%), and recurrent tracheoesophageal fistulas (3-10%). These complications often require complex surgical approaches, increasing the risk of dehiscence and fistula, especially under tension or with poor tissue quality. Management can be conservative, endoscopic, or surgical.

Clinical case: We report the successful closure of an anastomotic leak after esophageal atresia type III repair using endo-VAC (Endoscopic Vacuum-Assisted Closure) in a Mexican hospital. A full-term newborn underwent thoracoscopic repair for type III esophageal atresia with a three-vertebra gap. After surgery, on day 7 post-op, a contrast study and endoscopy revealed a 3 mm anastomotic leak to the airway. An endo-VAC system (assembled with adapted materials, 100 mmHg negative pressure) was placed. After 72 hours, endoscopy showed the defect had reduced by 50%. Following a change of endo-VAC, another three days later, endoscopy confirmed no leak at the anastomosis. The patient began oral feeding and, after one week, a control endoscopy showed no refistulization, leak, or stenosis, with continued favorable progress and adequate weight gain.

Conclusion: E-Vac therapy, originally used for skin grafts and chronic wounds, was adapted for esophagogastric fistulas in adults from 2008, and more recently in pediatric post-surgical leaks. It works by maintaining continuous negative pressure via a sponge-drain system, promoting secondary closure. Despite the limited availability of pediatric-specific equipment, reported success rates are high—typically 95% of patients experience favorable outcomes, as demonstrated in this case.