Thoracoscopic Stapling Ligation of H-Type Tracheo-Esophageal Fistula: A Viable and Safe Technique

Introduction: H-type tracheo-esophageal fistula (TEF) is rare. Different techniques of fistula ligation are practiced around the world. The aim of this study is to report our experience of thoracoscopic stapling ligation and division of the TEF. Methods: Retrospective review of patients who underwent thoracoscopic ligation of H-type TEF from April 2016 to January 2024. The diagnosis was made with a preoperative esophagram and confirmed with intraoperative rigid bronchoscopy. The procedure was standardized and in all cases, a 5 mm laparoscopic stapler was used to ligate and divide the TEF. Demographics, operative details, and complications were collected and analyzed. Results: A total of 12 patients were included (7 males) during the 8-year study period. The median age at surgery was 2.5 months (IQR: 1-3), and the median gestational age at birth was 38 weeks (IQR: 35-39). The median weight was 4.8 kg (IQR: 3-5). One case was a redo surgery of a failed ligation by a different surgeon, and another had two previous endoscopic ablation attempts. The median operative time was 55 minutes (IQR: 45-79), and there were no conversions to thoracotomy. None of the patients experienced recurrence of the TEF, esophageal leak or stenosis, or recurrent laryngeal nerve injury. Conclusion: The thoracoscopy approach to H-type TEF is feasible and allows a clear visualization of the fistula and the surrounding anatomical structures. The use of a 5 mm laparoscopic stapler represents a superior, reproducible, and safe method of ligating the fistula with no reported complications in this series.