Cervical approach for the repair of esophageal atresia.

Repair of esophageal atresia is usually performed by a thoracic approach. In cases associated with a tracheoesophageal fistula (TEF) located in a high position, however, the cervical approach is a reasonable alternative. In the literature, the authors found only three patients repaired by this approach. This report describes three additional cases of esophageal atresia successfully repaired by the cervical approach. Three neonates with esophageal atresia and TEF were confirmed as having an unusually high position of the distal TEF by the preoperative bronchoscopy and contrast study. The transcervical approach for repair was chosen. The skin was incised transversely at the right supraclavicular region, and the sternocleidomastoid muscle and the carotid sheath were retracted posterolaterally. After the division of the TEF, the suture site of the tracheal fistula was covered by a flap of the sternothyroid muscle that was inserted between the trachea and the esophagus, thus avoiding opposing suture lines. These cases emphasize that pediatric surgeons should be aware of the presence of cervical esophageal atresia in which distal TEF is located above the clavicle, and suggest that cervical repair is feasible for the patient whose distal TEF moves up above the first rib on inspiration. The most reliable methods for detecting the location of the distal TEF are telescopic bronchoscopy and contrast study.