Thoracoscopic Repair of Congenital Tracheoesophageal Fistula in an Adult

A 43-year-old female patient was referred to the hospital for evaluation with complaints of chronic cough that worsened while eating. Her medical history was uneventful other than a few episodes of right-side pneumonia during childhood. Computed tomography (CT) imaging raised the suspicion of a tracheoesophageal fistula (TEF)10 cm proximal to the bifurcation of the trachea. Bronchoscopy established the diagnosis of proximal, probably congenital TEF.  

The patient underwent video-assisted thoracoscopic surgery (VATS) repair. The surgeons placed the patient between prone and lateral surgical positions at a 45-degree angle, right side up. A camera port was inserted in the eighth intercostal space on the lateral posterior aspect of the chest, and a working incision was made in the fifth intercostal space on a lateral aspect of the chest. After releasing all pleural adhesions, the surgeons entered the posterior mediastinum above the level of the azygos vein. Local lymph nodes were dissected, and the space between the esophagus and the trachea was developed. The esophagus was placed on a sling, and the dissection continued until the surgeons could clearly assess the fistula margins. The fistula structure was also placed on a sling. The surgeons used a curved-tip vascular linear stapler to close and sever the fistula. The esophagus side stump was reinforced with a parietal pleura flap. The authors left a 28 French silicone drain and a 19 French Blake drain near the repair site.  
A CT swallow study was performed on postoperative day two, which demonstrated closure of the fistula with no sign of contrast leakage. 

The patient was discharged on postoperative day three with instructions for a liquid diet for two weeks, followed by a soft diet for another month. At follow-up in the outpatient clinic a few months after surgery, the patient reported that all symptoms had resolved. 

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