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Eur J Pediatr Surg
DOI: 10.1055/a-2072-9754
Original Article

Are Low Weight or Cardiopathy Contraindications for Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula?

Carlos Cadaval
1   Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain
,
José Andrés Molino 
1   Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain
,
Gabriela Guillén
1   Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain
,
Sergio López Fernández
1   Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain
,
Carmen López Hierro
2   Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain
,
Marta Martos Rodríguez
1   Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain
,
Haider Ali Khan
2   Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain
,
Elena Vilardell
3   Division of Pediatric Anestethesiology, Universitat Autónoma de Barcelona, Barcelona, Spain
,
Eva Andreu
3   Division of Pediatric Anestethesiology, Universitat Autónoma de Barcelona, Barcelona, Spain
,
César W. Ruiz
4   Division of Neonatology, Universitat Autónoma de Barcelona, Barcelona, Spain
,
Manuel López
2   Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain
› Author Affiliations Funding None.
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Abstract

Background Thoracoscopic repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is becoming an increasingly widespread technique; there is still controversy about its indication in certain patients. Our objective is to analyze if potential risk factors such as major congenital heart disease (CHD) or low birth weight (LBW) are a limitation to this approach.

Methods Retrospective study (2017–2021) of patients with EA and distal TEF who underwent thoracoscopic repair were included. Patients with LBW less than 2,000 g or major CHD were compared with the rest.

Results Twenty-five patients underwent thoracoscopic surgery. Nine patients (36%) had major CHD. Five of them (20%) were LBW less than 2,000 g, and only 8% (2/25) presented both risk factors. There were no differences in terms of operative time, conversion rate, tolerance evaluated with gasometric parameters (pO2, pCO2, pH) or complications (anastomotic leak and stricture, both early or during follow-up) in patients with major CHD and LBW (1,473 ± 319 vs. 2,664 ± 402 g). One conversion to thoracotomy was performed in a neonate weighing 1,050 g due to anesthetic intolerance. There was no recurrence of TEF. One patient died at the age of 9 months, due to major uncorrectable heart disease.

Conclusion Thoracoscopic repair of EA/TEF is feasible technique in patients with CHD or LBW, with similar results to other patients. The complexity of this technique warrants individualizing the indication in each case.

Level of Evidence IV.

Keywords

thoracoscopic - esophageal atresia - congenital heart disease - low birth weight - newborn


Publication History

Received: 04 February 2023

Accepted: 11 April 2023

Accepted Manuscript online:
13 April 2023

Article published online:
19 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Rothenberg S. Thoracoscopic repair of esophageal atresia and tracheo-esophageal fistula in neonates: the current state of the art. Pediatr Surg Int 2014; 30 (10) 979-985
    CrossrefPubMedGoogle Scholar
  • 2 Tanny SPT, King SK, Comella A. et al. Selective approach to preoperative echocardiography in esophageal atresia. Pediatr Surg Int 2021; 37 (04) 503-509
    CrossrefPubMedGoogle Scholar
  • 3 Way C, Wayne C, Grandpierre V, Harrison BJ, Travis N, Nasr A. Thoracoscopy vs. thoracotomy for the repair of esophageal atresia and tracheoesophageal fistula: a systematic review and meta-analysis. Pediatr Surg Int 2019; 35 (11) 1167-1184
    CrossrefPubMedGoogle Scholar
  • 4 Yang YF, Dong R, Zheng C. et al. Outcomes of thoracoscopy versus thoracotomy for esophageal atresia with tracheoesophageal fistula repair: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2016; 95 (30) e4428
    CrossrefPubMedGoogle Scholar
  • 5 Borruto FA, Impellizzeri P, Montalto AS. et al. Thoracoscopy versus thoracotomy for esophageal atresia and tracheoesophageal fistula repair: review of the literature and meta-analysis. Eur J Pediatr Surg 2012; 22 (06) 415-419
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Broemling N, Campbell F. Anesthetic management of congenital tracheoesophageal fistula. Paediatr Anaesth 2011; 21 (11) 1092-1099
    CrossrefPubMedGoogle Scholar
  • 7 Krosnar S, Baxter A. Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: anesthetic and intensive care management of a series of eight neonates. Paediatr Anaesth 2005; 15 (07) 541-546
    CrossrefPubMedGoogle Scholar
  • 8 Ron O, De Coppi P, Pierro A. The surgical approach to esophageal atresia repair and the management of long-gap atresia: results of a survey. Semin Pediatr Surg 2009; 18 (01) 44-49
    CrossrefPubMedGoogle Scholar
  • 9 Fernandes E, Kusel A, Evans S, Houghton J, Hamill JK. Is thoracoscopic esophageal atresia repair safe in the presence of cardiac anomalies?. J Pediatr Surg 2020; 55 (08) 1511-1515
    CrossrefPubMedGoogle Scholar
  • 10 Ishimaru T, Fujiogi M, Michihata N. et al. Impact of congenital heart disease on outcomes after primary repair of esophageal atresia: a retrospective observational study using a nationwide database in Japan. Pediatr Surg Int 2019; 35 (10) 1077-1083
    CrossrefPubMedGoogle Scholar
  • 11 Rothenberg SS. Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula in neonates, first decade's experience. Dis Esophagus 2013; 26 (04) 359-364
    CrossrefPubMedGoogle Scholar
  • 12 Lal DR, Gadepalli SK, Downard CD. et al; Midwest Pediatric Surgery Consortium. Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2017; 52 (08) 1245-1251
    CrossrefPubMedGoogle Scholar
  • 13 Pini Prato A, Carlucci M, Bagolan P. et al. A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2015; 50 (09) 1441-1456
    CrossrefPubMedGoogle Scholar
  • 14 Lawal TA, Gosemann JH, Kuebler JF, Glüer S, Ure BM. Thoracoscopy versus thoracotomy improves midterm musculoskeletal status and cosmesis in infants and children. Ann Thorac Surg 2009; 87 (01) 224-228
    CrossrefPubMedGoogle Scholar
  • 15 Patkowsk D, Rysiakiewicz K, Jaworski W. et al. Thoracoscopic repair of tracheoesophageal fistula and esophageal atresia. J Laparoendosc Adv Surg Tech A 2009; 19 (Suppl. 01) S19-S22
    CrossrefPubMedGoogle Scholar
  • 16 van der Zee DC, Tytgat SHAJ, Zwaveling S, van Herwaarden MYA, Vieira-Travassos D. Learning curve of thoracoscopic repair of esophageal atresia. World J Surg 2012; 36 (09) 2093-2097
    CrossrefPubMedGoogle Scholar
  • 17 Dingemann C, Ure BM. Minimally invasive repair of esophageal atresia: an update. Eur J Pediatr Surg 2013; 23 (03) 198-203
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Okuyama H, Saka R, Takama Y, Nomura M, Ueno T, Tazuke Y. Thoracoscopic repair of esophageal atresia. Surg Today 2020; 50 (09) 966-973
    CrossrefPubMedGoogle Scholar
  • 19 Wu Y, Kuang H, Lv T, Wu C. Comparison of clinical outcomes between open and thoracoscopic repair for esophageal atresia with tracheoesophageal fistula: a systematic review and meta-analysis. Pediatr Surg Int 2017; 33 (11) 1147-1157
    CrossrefPubMedGoogle Scholar
  • 20 Holcomb III GW. Thoracoscopic surgery for esophageal atresia. Pediatr Surg Int 2017; 33 (04) 475-481
    CrossrefPubMedGoogle Scholar
  • 21 Bishay M, Giacomello L, Retrosi G. et al. Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia: results of a pilot randomized controlled trial. Ann Surg 2013; 258 (06) 895-900
    CrossrefPubMedGoogle Scholar
  • 22 Son J, Jang Y, Kim W. et al. Thoracoscopic repair of esophageal atresia with distal tracheoesophageal fistula: is it a safe procedure in infants weighing less than 2000 g?. Surg Endosc 2021; 35 (04) 1597-1601
    CrossrefPubMedGoogle Scholar
  • 23 Iacona RV, Saxena AK. Thoracoscopic repair of esophageal atresia with distal tracheoesophageal fistula (type C): systematic review. Surg Laparosc Endosc Percutan Tech 2020; 30 (04) 388-393
    CrossrefPubMedGoogle Scholar