Thoracoscopic ligation of a tracheoesophageal H-type fistula in a newborn.

An H-type fistula represents the isolated form of tracheoesophageal fistula, and it is relatively uncommon. Conventional thoracotomy is associated with significant late sequelae; scapula alata, scoliosis, and excessive scarring [Konkin DE, O'hali WA, Webber EM, Blair GK. Outcomes in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2003;38:1726-9]. Thoracoscopic approaches avoid these consequences. Thoracoscopic repair of esophageal atresia, together with fistula ligation, has been performed earlier [van der Zee DC, Bax NM. Thoracoscopic repair of esophageal atresia with distal fistula. Surg Endosc 2003;17:1065-7]. Thoracoscopic repair of H-type fistula was not attempted before. This is probably because most H-type fistulas are high enough to be accessible through a neck incision. Low fistulas are better approached via the thorax. To our knowledge, this is the first report of a thoracoscopic approach to an H-type tracheoesophageal fistula in a newborn.