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

Carlos Cadaval; José Andrés Molino; Gabriela Guillén; Sergio López Fernández; Carmen López Hierro; Marta Martos Rodríguez; Haider Ali Khan; Elena Vilardell; Eva Andreu; César W. Ruiz; Manuel López

doi:10.1055/a-2072-9754

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2024; 34(04): 301-305
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

¹Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain

,

José Andrés Molino

¹Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain

,

Gabriela Guillén

¹Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain

,

Sergio López Fernández

¹Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain

,

Carmen López Hierro

²Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain

,

Marta Martos Rodríguez

¹Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain

,

Haider Ali Khan

²Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain

,

Elena Vilardell

³Division of Pediatric Anestethesiology, Universitat Autónoma de Barcelona, Barcelona, Spain

,

Eva Andreu

³Division of Pediatric Anestethesiology, Universitat Autónoma de Barcelona, Barcelona, Spain

,

César W. Ruiz

⁴Division of Neonatology, Universitat Autónoma de Barcelona, Barcelona, Spain

,

Manuel López

²Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain

› Author Affiliations

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

Full Text

References

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