THORACOSCOPIC REMOVAL OF RESIDUAL BURNED ESO- PHAGUS

Introduction The most frequent cause of esophagectomy in chil- dren is the presence of strictures related to the ingestion of corrosive agents. When dilatations of burned esopha- gus are not feasible due to high risk of rupture or when those are unsuccessful, surgical treatment is mandatory. Operative strategy is controversial regarding esophageal substitution and timing of surgery, while the need for eso- phagectomy to avoid risk of cancer is internationally re- cognised.We report one case of thoracoscopic esophagec- tomy as a delayed intervention after open esophagoco- lonplasty in a child with a burned esophagus. Materials and methods A two years old child with a severe esophageal steno- sis for accidental ingestion of liquid caustic soda, reached our institution from Mali. A retrosternal isoperistaltic esofagocolonplasty was realised without removing the esophagus. 11 months later the child underwent a com- plete right thoracoscopic esophagectomy. The patient was positioned in a left lateral decubitus and five trocars were used. A 5 mm for the telescope was positioned at the seventh intercostal space on the midaxillary line. Two 5 mm operative trocars were placed at the fifth and nineth intercostal space posteriorly to the optic, while two 3 mm trocars were positioned anteriorly to the optic to retract the lung. A single lung ventilation was used. The azigos vein was sectioned and the residual esophagus dissected with a monopolar hook and his lower tract was separated from the stomach with a stapler. The defunc- tioned esophagus was removed from a 5 mm port. Results The toracid drain was removed after 24 h and no respi- ratory problem was seen. The patient was discharged after 11 days and came back to his country in a good condition. Discussion Open esophagectomy can be associated with high morbidity and delayed return to routine activities. Tho- racoscopic esophagectomy have been proposed both for benign and malignant pathology in adults, while in chil- dren the esperience is still poor. In case of caustic burned esophagus, the intense fibrosis and adherences can lead to accidental lesions of the mediastinal structures. Lapa- roscopic magnification can allow a secure controll of the situation. In our opinion thoracoscopic esophagectomy, in expert hands, can be performed avoiding the risk of long term morbidity of scoliosis, shoulder muscle girdle weakness, and chest wall deformities.