CASES OF THORACOSCOPIC TREATMENT OF PATIENTS WITH ESOPHAGEAL ATRESIA AND RIGHT AORTIC ARCH

Right aortic arch (RAA) is one of the vascular anomalies associated with esophageal atresia (EA). Surgical treatment of this combination of congenital malformations is difficult. Cases described in this article were identified during surgery and corrected by thoracoscopy through access in the right pleural cavity. This retrospective research was based on the personal experience of a single surgeon who performed surgical interventions for EA in RAA in 9 patients in 3 different sites located in the cities of Irkutsk and Ulan-Ude (both in Russia) and Tashkent (Uzbekistan) over the past 10 years starting Jan. 2012. The postoperative results of treatment were evaluated as well. In all patients, an abnormal aortic arch was detected during surgery. All patients had the most common type C esophageal atresia. The mean weight of patients at the time of surgery was 2383.3±242.4 g (median 2400.0 [2150.0; 2552.0] g). The mean gestational age was 35.1±3.7 weeks (median 36.0 [34.5; 37.5] weeks). Other congenital heart anomalies were observed in 3 (33%) patients: two (22%) ventricular septal defects and a single (11%) tetralogy of Fallot (TOF). All 9 patients underwent thoracoscopic reconstruction of the esophagus through the right hemithorax. The mean surgical intervention duration was 88.9±12.7 min (median 90.0 [80.0; 100.0] min). One lethal outcome (11%) was registered in a patient with TOF and critical pulmonary stenosis. One patient (11%) was diagnosed with an anastomotic leak on the 7th day after the intervention, which closed on its own 7 days after. Two patients (22%) required dilatation of the resulting esophageal stenosis, which required 1 to 2 balloon dilatations performed within one year after the surgery. In the long-term follow-up period, 8 surviving patients (89%) with EA and RAA had their own esophagus preserved, which allowed them to eat independently. Conclusion: EA reconstruction in patients with RAA can be safely performed using the right-sided thoracoscopy.