Kirtikumar J Rathod, MBBS, MS, MCh; Ayushi Vig; Arvind Sinha; AIIMS Jodhpur
Aim: A rare case of TEF in which the upper and the lower pouch were sharing a common wall making intraoperative delineation of anatomy difficult.
A 5mm camera port was inserted in the anterior axillary line in the 5th space. Two working 3mm ports were inserted under direct vision. Azygous vein was identified and preserved. The lower esophageal pouch was identified and dissection was performed . However dissection was difficult as the upper pouch was seen overlapping the lower pouch. The lower and upper pouch sharing a common wall for approximately 1 cm length. TEF was not visualised initially as it was lying posterior to the upper pouch. The common wall was separated and the upper and lower ends were dissected circumferentially.
TEF was identified and clipped. The fistula was doubly clipped Upper pouch dissection was performed and edges freshened and anastomosis performed in a single layer using Vicryl 5-0.