Minimally Invasive Repeat Revision of Substernal Colon Interposition

This video presents the case of a patient with a very complex medical history. She was born with esophageal atresia and tracheo-esophageal fistula. She underwent an attempted primary repair, but it failed. An attempt at a substernal gastric pull-up also failed. In her first six months, the patient underwent 20 different procedures for reconstruction and management of surgical complications. The patient had a cervical esophageal stoma and G-tube until seven years of age, when she underwent a repeat sternotomy and substernal colon interposition. She did well until age 12, and underwent revision of her colon interposition and colo-pexy for a redundant dilated colon. At 20-years-old, the patient underwent a completion esophagectomy for chronic tracheal fistula to the remnant mucocoele. She had multiple small bowel operations, as well as three abdominal hernia repairs. At 32 years of age, she underwent a left thoracotomy and lower lobectomy for chronic bronchiectasis. At 42, the patient developed an inability to tolerate an oral diet secondary to recurrent redundancy of her colon interposition. The authors performed a minimally invasive revision of her substernal colon interposition with a hand port, laparoscopic ports, and a left thoracoscopic port.