CERVICAL APPROACH FOR THE REPAIR OF ESOPHAGEAL ATRESIA

Repair of esophageal atresia is usually performed by a thoracic approa ch. In cases associated with a tracheoesophageal fistula (TEF) located in a high position, however, the cervical approach is a reasonable al ternative. In the literature, the authors found only three patients re paired by this approach. This report describes three additional cases of esophageal atresia successfully repaired by the cervical approach. Three neonates with esophageal atresia and TEF were confirmed as havin g an unusually high position of the distal TEF by the preoperative bro nchoscopy and contrast study. The transcervical approach for repair wa s chosen. The skin was incised transversely at the right supraclavicul ar region, and the sternocleidomastoid muscle and the carotid sheath w ere retracted posterolaterally. After the division of the TEF, the sut ure site of the tracheal fistula was covered by a flap of the sternoth yroid muscle that was inserted between the trachea and the esophagus, thus avoiding opposing suture lines. These cases emphasize that pediat ric surgeons should be aware of the presence of cervical esophageal at resia in which distal TEF is located above the clavicle, and suggest t hat cervical repair is feasible for the patient whose distal TEF moves up above the first rib on inspiration. The most reliable methods for detecting the location of the distal TEF are telescopic bronchoscopy a nd contrast study. Copyright (C) 1995 by W.B. Saunders Company