The most popular type of esophageal atresia is esophageal atresia with a distal tracheoesophageal fistula (TEF), namely, Gross type C. Division of TEF and primary anastomosis of the esophagus are essential. One-layer stitch anastomosis with monofilament absorbable sutures (5-0 or 6-0 PDS) is the most standard procedure for end-to-end anastomosis. Muscle-sparing axillary skin crease incision achieved excellent motor and aesthetic outcomes. The patient is placed in the left lateral position. The uppermost right arm was extended to about 130°, drawn forward, and placed on an armrest. A pulse oximeter is applied on hand of the extended right arm for monitoring peripheral blood pulse and saturation of oxygen. During operation, blood pulse and saturation of oxygen have been kept in normal range in order to avoid transient arm paralysis caused by the hyperextension of arm or the hyperextension of wound. Extrapleural approach through the fourth intercostal space allows the identification of azygos vein, TEF, and upper pouch. The azygos vein was identified and ligated with 4-0 silk and divided; then, the upper esophagus and TEF are exposed. Vagus nerve is present besides the upper esophagus. TEF is identified along the vagus nerve. TEF is encircled by tape and divided nearby trachea and closed by 5-0 PDS stitch sutures. Esophageal end-to- end anastomosis was followed. Thorax and skin wound is closed in layers.
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