BACKGROUND
The treatment of patients with type B esophageal atresia and right aortic arch deserves special consideration. To date, there are no recommendations regarding the choice of a treatment strategy and the optimal method of correction in patients with type B esophageal atresia combined with the right aortic arch. The present study demonstrates a case of successful use of a delayed esophageal anastomosis with its atresia in combination with a proximal tracheoesophageal fistula and the right aortic arch.
MATERIAL AND METHODS
The clinical case is presented by a newborn boy who was born prematurely at a gestational age of 28 weeks, in whom esophageal atresia was found during postnatal examination. The baby’s birth weight was 1200 grams. On examination, signs characteristic of Down’s disease were noted. Genetic analysis confirmed these assumptions and revealed a rare form of genetic disease associated with a duplication of the shoulder of chromosome 21. Diastasis between segments was about 5 cm. Taking into account the small weight of the child and the presence of long-gap diastasis, characteristic of the non-fistulous form of esophageal atresia, a staged reconstruction of the esophageal malformation was chosen as a treatment strategy, suggesting gastrostomy immediately after the patient was born and delayed anastomosis of the esophagus in expectation of its growth a few weeks after birth. At the age of 8 weeks, when the child’s body weight was 2600 grams, a thoracoscopic esophageal anastomosis was performed.
RESULTS
The duration of the operation was 130 minutes. Surgical intervention was not accompanied by complications such as bleeding and cardiorespiratory instability. As a result of the fact that the anastomosis of the esophagus was created under tension, prolonged muscle relaxation was required for five days. In order to reduce tissue tension in the area of the connected segments, tracheal cannulation continued for 7 days. Enteral nutrition began on the 5th day of the postoperative period in small amounts through a nasogastric tube. The drainage tube from the posterior mediastinum was removed on the 9th day after the contrast radiographic examination of the esophagus was performed. One month after the operation, signs of anastomotic stenosis were noted in the form of difficulty in swallowing and regurgitation. Balloon dilation performed allowed to get rid of these symptoms. During the next 6 months of observation, another session of balloon expansion was required, after which the signs of anastomotic stenosis no longer recurred.
CONCLUSION
The thoracoscopic method for the reconstruction of esophageal atresia under conditions of the right aortic arch is laborious, complex and requires a lot of experience, but it should be considered as the procedure of choice. This is the main reason why patients with long-gap esophageal atresia should only be treated in expert centers or at the invitation of specialists with experience in performing a large number of thoracoscopic operations in order to ensure the best quality of treatment for such patients.