Отсроченный торакоскопический анастомоз при изолированной форме атрезии пищевода

This article presents the results of the treatment of infants with long gap esophageal atresia using the delayed esophageal anastomosis strategy. Material and methods. Delayed thoracoscopic reconstruction of long gap esophageal atresia was performed by one surgeon in 6 patients (4 boys and 2 girls) aged 6 to 16 weeks with R. Gross type A esophageal atresia. The infants were treated in 4 surgical centers located in the cities of Irkutsk, Tomsk, Kemerovo and Tashkent (Uzbekistan). In all patients, a thoracoscopic approach was used through the right hemithorax. In the final part of the study, the postoperative results of treatment were evaluated. Results. At the first stage, all patients underwent open gastrostomy. The average waiting time for esophageal growth was 10.2±3.6 weeks (median – 9.5 [7.5; 13.0] weeks). The average weight of patients by the time of the second stage of treatment – delayed esophageal anastomosis – was 4033.3±326.6 g (median – 4150.0 [3850.0; 4225.0] g). The mean operation time was 98.3±14.7 minutes (median – 95.0 [87.5; 112.5] minutes). 1 (17%) patient was diagnosed with an anastomotic leak on the 7^th day after the operation, which closed on its own in 10 days. 5 (83%) patients required dilatation of the resulting esophageal stenosis, which required 3–6 balloon dilatations performed within one year after surgery. In the long-term follow-up period of 12 months, all surviving patients with long gap esophageal atresia had their own esophagus preserved, which allowed them to eat independently. Conclusion. Surgical reconstruction of esophageal atresia in patients with long gap esophageal atresia is possible in the conditions of regional and republican surgical centers using delayed thoracoscopic anastomosis of the esophagus, performed through an access in the right hemithorax, and is accompanied by acceptable postoperative results. An experienced surgeon who knows the technique of this operation is the main condition for the optimal outcome of the treatment of such patients.