Tracheomalacia in newborns and infants is a significant surgical problem. Until now, there was only one effective treatment for
tracheomalacia – aortopexy. This paper presents the initial experience of new surgical procedure in a newborn with esophageal
atresia and tracheomalacia – posterior tracheopexy using thoracoscopy.
At the Neonatal Surgical Center of the Ivano-Matreninskaya Municipal Pediatric Clinical Hospital (Irkutsk), a newborn boy
weighing 2720 g was treated at 40 weeks of gestation. The diagnosis of an esophageal abnormality was established prenatally at
the gestation period of 33 weeks. Contrast X-ray examination of the esophagus after birth confirmed the diagnosis of type C esophageal atresia. From the moment of birth, the child had respiratory disorders, which increased in time.
Tracheobronchoscopy documented that respiratory problems were due to tracheomalacia. The indication for posterior tracheopexy
was the presence of severe respiratory disorders caused by complete prolapse of the membranous part of the trachea.
The posterior tracheopexy was performed by placing two PDS II 5/0 stitches between the membranous part of the trachea and
the anterior longitudinal ligament of the spinal column so that the posterior wall of the trachea was fixed to the spine for about
1.0 cm. The next step was the performing of the esophageal anastomosis.
The operation of simultaneous thoracoscopic correction of esophageal atresia and tracheomalacia was not accompanied by
complications. The duration of the surgery was 85 min. Posterior tracheopexy did not cause additional difficulties while performing
the esophageal anastomosis. The duration of mechanical ventilation after surgery was 1 day. The trachea was decanulated
on the 3rd day after surgery. The enteral nutrition by mouth started on the 7th postoperative day. On the 10th day of life,
tracheobronchoscopy was performed, which demonstrated the complete opening of the lumen of the trachea with minimal prolapse
of the membranous part in the second segment of the trachea. Five-month follow up did not reveal an increase in the
symptoms of respiratory disorders.
This case report has demonstrated the possibility of performing the posterior tracheopexy for treating tracheomalacia in patients
with esophageal atresia. It was shown that the operation may be performed by thoracoscopic approach simultaneously with the
construction of the esophageal anastomosis.
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About the authors
- Kozlov Yu.A., http://orcid.org/0000-0003-2313-897X
Rasputin A.A., http://orcid.org/0000-0002-5690-790X
Kovalkov K.A., http://orcid.org/0000-0001-6126-4198
Baradieva P.Z., http://orcid.org/0000-0002-5463-6763