WOFAPS 2025 8th World Congress of Pediatric Surgery

Paulina Vargova, Ricardo Escartin Villacampa, Andrea Santino Tenorio, Paolo Bragagnini Rodriguez

Hospital Universitario Miguel Servet

Aim of the study:

H-type tracheoesophageal fistula (TEF) is a rare anomaly, accounting for 4-5% of all congenital esophageal malformations. The surgical management of this condition varies among centres, with thoracoscopic approaches and different ligature techniques gaining popularity.

We present a case report of congenital tracheoesophageal fistula successfully treated through thoracoscopic ligation using a metal clip without sectioning the fistula.

Case description:

A 36+2-week gestation newborn, weighing 1950 grams, presented with regurgitation and desaturation during feedings at 6 hours of life. Transferred to our centre at three days old with suspected congenital tracheoesophageal fistula (TEF), a chest X-ray revealed areas of increased density in the right upper lobe. An esophagogram confirmed the suspicion of TEF. The contrast passed from the esophagus to the left posterolateral tracheal wall through a 2.5mm communication located 18mm from the carina.

At ten days of life, we perform a thoracoscopic surgery using three trocars. We identificate, dissect and ligate the tracheoesophageal fistula, preserving the azygos vein. The fistula is ligated with two metal clips and left intact.

A postoperative esophagogram confirmed the absence of leakage, and she initiated oral feeding. The patient was discharged six days after the intervention.

Conclusions:

Thoracoscopic ligation is a viable and satisfactory procedure for H-type TEF using metal clip ligation without sectioning the fistula, demonstrating successful outcomes as a treatment of choice.