24. Thoracoscopic Repair Of Esophageal Atresia and Tracheoesophageal Fistula: A Multi-Institutional Analysis
George W. Holcomb, III, MD, MBA1, Steven S. Rothenberg, MD*2, Klaas M.A. Bax, MD, PhD*3, Keith E. Georgeson, MD4, Marcelo M. Ferro, MD*5, Craig T. Albanese, MD*6, Daniel J. Ostlie, MD*1, David C. van der Zee, MD3, PhD.*, C.K. Yeung, MD, PhD*6
1Children's Mercy Hospital, Kansas City, MO; 2Presbyterian-St. Lukes Hospital, Denver, CO; 3Wilhelmina Children's Hospital, Utrecht, The Netherlands; 4Children's Hospital of Alabama, Birmingham, AL; 5National Children'sHospital, Buenos Aires, Argentina; 6Lucille Packard Children's Hospital, Stanford, CA; 7Chinese University of Hong Kong, Hong Kong, China
Objectives For the past 60 years, repair of esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) has been performed through a thoracotomy. However, a number of reports have detailed adverse musculoskeletal sequelae following thoracotomy. Until now, there have only been scattered case reports detailing an individual surgeon’s success with thoracoscopic repair. This multi-institutional review represents the largest report describing this approach.
A cohort of international pediatric surgeons from centers that perform advanced laparoscopic and thoracoscopic operations in infants and children retrospectively reviewed their data on primary thoracoscopic repair in 110 newborns with EA/TEF. Newborns with EA without a distal TEF or babies with an isolated TEF without EA were excluded.
Results: 110 Patients
|Mean age (days)||1.3 (+/-1.2)|
|Mean weight (kg)||2.7 (+/- 0.5)|
|Mean operative time (minutes)||130.7 (+/- 56.5)|
|Mean days mechanical ventilation||3.7 (+/-5.9)|
|Mean days total hospitalization||18.3 (+/-18.9)|
|Patients with leak and/or stricture||12|
|Patients requiring esophageal dilatation||37|
|Operations that were converted or staged||8|
|Patients requiring laparoscopic fundoplication||26|
A number of other operations were required, including imperforate anus repair (7), thoracoscopic aortopexy (7), laparoscopic duodenal atresia repair (4), and various cardiac operations (6). Three patients died, one related to the EA/TEF on the 20th postoperative day.
Conclusions The thoracoscopic repair of EA/TEF represents a natural evolution in the operative correction of this congenital anomaly and can safely be performed by experienced endoscopic surgeons. The results presented are comparable to previous reports of babies undergoing repair through a thoracotomy. Based on the associated musculoskeletal problems following thoracotomy, there will likely be long-term benefits for babies with this anomaly undergoing the thoracoscopic repair.