Thoracoscopic Aortopexy for Tracheomalacia

• Published in: World journal of surgery Vol. 39; no. 1; pp. 158 - 164
• Main Authors: van der Zee, David C., Straver, Marieke
• Format: Journal Article
• Language: English
• Published: Boston Springer US 2015; Springer Nature B.V
• Subjects: Abdominal Surgery; Antireflux Procedure; Aorta - surgery; Brachiocephalic Artery; Cardiac Surgery; Esophageal Atresia; Esophageal Atresia - surgery; Female; General Surgery; Humans; Infant; Infant, Newborn; Male; Medicine; Medicine & Public Health; Original Scientific Report; Recurrence; Retrospective Studies; Stab Wound; Surgery; Thoracic Surgery; Thoracoscopic Approach; Thoracoscopy - methods; Thoracotomy; Tracheomalacia - surgery; Vascular Surgery; Vascular Surgical Procedures; Esophageal Atresia; Thoracoscopic Approach; Stab Wound; Antireflux Procedure; Brachiocephalic Artery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-014-2798-2

Background Tracheomalacia is a condition that may result in acute life-threatening events. Aortopexy has become a generally accepted mode of treatment, although the impact of a thoracotomy is considerable. With the advent of minimal invasive surgery the impact of such a procedure may be greatly reduced. This study evaluates the outcome of thoracoscopic aortopexy for tracheomalacia. Methods Retrospective analysis of a database containing all patients with thoracoscopic aortopexy. Based on symptomatology, on indication 24 h pH study and/or rigid tracheo-bronchoscopy were carried out to confirm the diagnosis. A three-trocar technique was used on the left side together with intra-operative flexible tracheoscopy through the tube. Follow-up continued for the duration of the study. Results Between January 2002 and December 2012, 16 patients presented with severe tracheomalacia. Fourteen of them had a history of esophageal atresia. Age at time of aortopexy varied from 2 weeks to 12 months. All procedures were performed thoracoscopically without intra-operative complications. In five children, there was a recurrence of symptoms within 2–4 weeks for which a re-thoracoscopic aortopexy was carried out successfully. With a follow-up of 6 months to 10 years all patients are thriving and are without incidents. Conclusion This is the largest single-center series of thoracoscopic aortopexy for tracheomalacia so far. All procedures were completed successfully without complications. Although recurrences occur, as in open surgery, the ultimate results are satisfactory. In an era of minimal invasive surgery the thoracoscopic approach is feasible and safe, even in redo-procedures.