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TÜRKÇE
Poster - 155
Feasibility of thoracoscopic repair of Oesophageal Atresia in the presence of aberrant vascular anatomy: A Case series and review
Sherif Mansour, John Hakiem, Dipankar Dass, Paul Cullis, Phil Hammond, Jimmy Lam, Fraser Munro
Royal Hospital for Children & Young People, Edinburgh, United Kingdom
Aim:
Thoracoscopic repair of oesophageal atresia (OA), with or without tracheoesophageal fistula (TOF), offers minimally invasive advantages—better cosmetic and musculoskeletal outcomes—without compromising safety. However, aberrant vascular anatomy (e.g., right-sided aortic arch, aberrant subclavian artery) can complicate repair, and limited evidence exists on its impact on thoracoscopic approaches.
Methods:
We retrospectively reviewed neonates with OA/TOF who underwent thoracoscopic repair at our institution (2001–2024) and had pre- or intraoperative detection of aberrant vascular anatomy. Data collected included demographics, anomaly type, operative details, need for intraoperative modifications, conversion to open surgery, complications, and short-term outcomes.
Results:
Three patients were included: two born at term (birth weights 3.5 kg and 2.38 kg) and one preterm infant (34+2 weeks, 2.2 kg) with additional anomalies (duodenal atresia and cloacal malformation). Vascular anomalies comprised right-sided aortic arch (n=2) and aberrant left subclavian artery (n=1). Age at surgery ranged from 2 days to 5 months. All underwent successful thoracoscopic repair; one required intracorporeal traction sutures for a long-gap atresia. Anastomoses were placed lateral to the vascular structures. Median operative time was 180 minutes (range 150–290). No intraoperative conversions occurred. One patient developed an anastomotic stricture, successfully treated with balloon dilatations; no leaks or ALTE episodes were observed. Follow-up ranged from 12–24 months, with outcomes comparable to standard cases.
Conclusion:
Thoracoscopic OA repair is feasible and safe even with aberrant vascular anatomy, provided careful preoperative imaging and intraoperative planning. Our experience supports favouring a thoracoscopic approach in these complex cases due to excellent anatomical visualisation and minimally invasive benefits.