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Published on: August 11, 2023
Laparoscopic partial circular myectomy for congenital esophageal stenosis due to tracheobronchial remnant
Kyoko Mochizuki1, Masato Shinkai1, Norihiko Kitagawa1
1Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
Insights
Laparoscopic partial circular myectomy is a safe and effective treatment for congenital esophageal stenosis (CES) in infants caused by tracheobronchial remnants (TBR). This minimally invasive approach successfully resolved stenosis, allowing infants to eat solid foods without vomiting.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Anomalies
Background:
- Congenital esophageal stenosis (CES) is a rare condition with unclear optimal management strategies.
- Tracheobronchial remnants (TBR) are an uncommon cause of CES, presenting unique surgical challenges.
Observation:
- A laparoscopic approach was used to identify a 1.5 cm segment of esophageal stenosis.
- The stenosis, located above the esophagogastric junction, exhibited a whiter, narrower appearance.
- Intraoperative findings included the identification of small, cartilage-like tissues within the narrowed esophageal segment.
Findings:
- Laparoscopic partial anterior 270° circular myectomy was performed, dissecting the esophageal muscle layers.
- The procedure involved interrupted suturing of the muscular layers at both ends of the resected segment.
- No intraoperative complications were observed during the myectomy.
Implications:
- This technique offers a potentially safe and effective minimally invasive option for short-segment lower esophageal stenosis due to TBR.
- Post-operative balloon dilation addressed residual stenosis, enabling the patient to tolerate solid food without vomiting.
- This case highlights the feasibility of laparoscopic partial circular myectomy in managing CES caused by tracheobronchial remnants in infants.
Abstract:
Congenital esophageal stenosis (CES) is a rare anomaly, and its appropriate management is not well established. This may be the first report describing laparoscopic partial circular myectomy of the esophageal wall in an infant with CES caused by tracheobronchial remnant (TBR). The narrow segment of the esophagus was laparoscopically detected 1 cm above the esophagogastric junction because the segment was whiter and narrower than the other parts of the esophagus. The narrow segment was approximately 1.5 cm in length. Partial anterior 270° circular muscle layers were dissected using hook electrocautery. Small cartilage-like tissues were identified during the procedure. The muscular layers of both ends were interruptedly sutured. Intraoperative complications were not detected. After undergoing balloon dilation for slight residual stenosis, the patient could eat solid foods without vomiting. Laparoscopic partial circular myectomy is safe and effective for short-segment lower esophageal stenosis in patients with CES caused by TBR.
