Muscle-Sparing Versus Standard Posterolateral Thoracotomy in Neonates With Esophageal Atresia

Abstract

Background : The muscle-sparing thoracotomy (MST) has not yet been thoroughly studied and assessed in comparison to the traditional thoracotomy method in newborns. Aim : To compare the outcomes of MST and standard posterolateral thoracotomy (PLT) in newborns. Methods : Randomized, controlled, double-blind trial on 40 neonates with esophageal atresia, comparing the time of beginning a surgery until seeing the pleura, the duration of hospitalization in the neonatal intensive care unit, the time in ventilator, the time of returning the shoulder function, the time of returning the Moro reflex, and the mortality between the two techniques. Results : The data showed no differences between the two groups in basic information (weight, height, gender, numbers of prematurity neonates and caesarean). The results on the size of the scar in the MST group was significantly lower than in the PLT group. Also, the time of returning the shoulder function in MST group was earlier than in PLT group. There were no significant differences in the duration since the beginning the surgery to see the pleura, the time of being hospitalized in intensive unit, the time that the infant required ventilator, returning time of the Moro reflex in 1st and 3rd months after the operation, and the mortality rates between MST and PLT groups. Conclusion : It seems that the advantages of using MST over PLT procedure in neonates include the earlier shoulder function recovery and also superior cosmetic results.

ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management

“…Askarpour et al recently confirmed better outcomes of muscle-sparing versus standard posterolateral thoracotomy in newborns. 47 This statement was adopted unanimously by the participants of the conference. However, advantages of the preservation of the azygos during esophageal atresia repair were confirmed in two randomized trials 48,49 but no consensus could be achieved on this topic.…”

Postoperative Osteopathic Manipulative Treatment in Children with Esophageal Atresia: Potential Benefits on the Anthropometric Parameters

“…In fact, a ROM deficit of the upper right limb is strongly documented in the literature [ 3 ]. Many studies consider the onset of scoliosis, thoracic deformities, scapular elevations, and limitation on the right shoulder ROM as a possible long-term postoperative risk [ 5 , 32 , 33 ].…”

“…A posterolateral thoracotomy is frequently used in pediatric surgery. It provides an adequate working space and access to the posterior mediastinum, allowing for expansion of the surgical field as needed in cases of technical difficulties or complications [ 3 , 4 , 5 ]. Through this incision, the surgeon cuts at least one (often the latissimus dorsi) or several major thoracic muscles such as the anterior dentate, trapezius, and rhomboid muscles [ 4 ].…”

“…This type of surgery may lead to severe complications such as acute postoperative pain, disturbance to lung dynamics, and a reduction in the performance of the right shoulder girdle [ 3 ]. In the long term, this surgical approach can generate comorbidities affecting the musculoskeletal system, such as the alteration of the scapulohumeral kinetics, morphological dysfunction of the spine such as thoracogenic scoliosis, and alterations of the respiratory kinetics, such as costal fusions [ 4 ].…”

Rings and Slings: Not Such Simple Things

“…Posterolateral muscle-sparing (MST) thoracotomy has been associated with less pain, better shoulder function, and earlier hospital discharge in the adult population [ 44 ]. Although pain scale is more difficult to assess in children [ 45 ], MST has shown faster shoulder recovery in some series [ 46 ] without compromising surgical exposure, even in children < 1 kg of weight [ 44 ], with the promise of reducing risk of orthopedic deformation. Despite limitations, pain can be indirectly measured in children based on hemodynamic parameters, presence of irritability, and the need of comfort [ 45 ], either with administration of pain medication or physical contact.…”