Thoracoscopy at the esophagus atresia with insuperable to diastases

Abstract

The main number of complications and unsatisfactory results in the surgical treatment of esophageal atresia associated with large diastases between segments, when after complete mobilization the acute and abdominal segment of the esophagus can not be linked. In our clinic, one patient as a primary operation and delayed anastomosis of the esophagus was made thoracoscopically. Newborn V. came to the clinic at the age of 4 hours of life with a clinical and radiological picture of esophagus atresia with a lower tracheotophageal fistula, high atresia of the anus. He was born in 35-36 weeks of gestation. Weight at birth 2156 g. After cooking the baby works. In thoracoscopy, after elimination of the lower tracheotophageal fistula and maximum isolation of the segments of the esophagus, diastases are 5 cm. Segments of the esophagus do not approach. A superposition of the transverse elongation of the esophagus on Fokera is performed. To feed the patient, laparoscopic removal of the pendulous enterostomy is performed, as well as due to the abnormality of the anorectal region-the laparoscopic formation of a double separate colostomy. Ten days later, the patient is taken for repeated thoracoscopy. Completed thoracoscopic anastomosis of the esophago-esophagus “ends at the end”. After a radiological examination with a water-soluble contrast on the 10th day, the baby begins to feed. The child developed chilothorax and chyloperitoneum. In accordance with the protocol of conservative treatment of chylothorax and choleopetonemia, the child was abolished enteral load, octreotide infusion, a full parenteral nutrition source was prescribed. Against the background of the therapy, the status stabilized, the lymph flow ceased. Enteral loading resumes after 15 days. Now the child is at home. Nutrition through the mouth in full, there is no dysphagia. He is preparing for operative treatment of atresia of the anus.