Reparación toracoscópica de atresia esofágica con y sin fistula traqueoesofágica

Abstract

Rev chil pediatr 2014; 85 (4): 443-447Recibido el 21 de marzo de 2013, última versión aceptada para publicación el 18 de febrero de 2014. Potenciales conflictos de interés:Este trabajo cumple con los requisitos sobre consentimiento /asentimiento informado, comité de ética, financiamiento, estudios animales y sobre la ausencia de conflictos de intereses según corresponda. of them with type III EA, 4 with type I and one unclassifiable, were part of the study. 13 patients underwent ligation, cut of tracheoesophageal fistula and end to end anastomosis. Two underwent laparoscopic gastrostomy and fistula ligation. One patient required conversion and underwent esophagostomy plus gastrostomy. 4 patients without fistula required laparoscopic gastrostomy and aspiration of the proximal esophagus to be able to perform esophageal anastomosis. In the postoperative period, pleural drainage and a transanastomotic feeding tube were installed. seven patients required esophageal dilations and 4 patients developed stenosis due to reflux. Two had recurrent fistula, one with spontaneous resolution and another with endoscopic resolution. three children died: two of them due to pathologies not related to surgery and one as a result of limitation of therapeutic effort after fistula patency. Discussion: esophageal atresia repair with MIs is a safe and effective option with excellent exposure and visualization of anatomic landmarks and little associated morbidity.

Thoracoscopic Esophageal Atresia Repair: Outcomes Analysis Between Primary and Staged Procedures

“…Thoracoscopic Approach to Delayed/staged Repairs 5,10,26,[35][36][37][38][39][40][41] In the 2 decades between 1999 and 2019, a total of 10 articles describing thoracoscopic staged repairs were identified and offered 73 neonates for this analysis (Table 2).…”

“…8 During the last 10 years, thoracoscopic repair of EA/TEF has become a standard procedure in many pediatric surgical centers, which was evident from a recent survey that showed that 46% preference for the thoracoscopic approach. 10,15 Outcomes of thoracoscopic approach have been reported to be comparable to open surgery. 22 More recently, this has also been confirmed in a meta-analysis comparing thoracoscopy with thoracotomy, which showed no significant differences between the approaches; with the exception of operative time.…”

“…Nonabsorbable sutures were used in 82 patients (5 articles), and the anastomotic leakage rate was higher in the series reported by these centers. 6,10,11,13,21 However, all cases of anastomotic leaks were managed conservatively. Variations in the size of the suture and the type of suturing technique did not appear not to correlate with anastomotic leaks.…”

“…Recently, thoracoscopic repair of EA has been accepted as a superior technique, not only from the esthetic point of view in that it eliminates thoracotomy and avoids morbidities such as a large scars, but also as this reduces morbidities such as scoliosis, thoracic cage deformities, and winged scapula 8. During the last 10 years, thoracoscopic repair of EA/TEF has become a standard procedure in many pediatric surgical centers, which was evident from a recent survey that showed that 46% preference for the thoracoscopic approach 10,15…”

Variáveis neonatais em recém-nascidos portadores de atresia esofágica

“…Além disso, análise de dados de 2015 da América Latina, observou-se que entre os diagnósticos efetuados durante a vida pós-neonatal, é possível perceber uma relação direta da AE com duas variáveis: idade gestacional e sexo masculino 8,9 . O tratamento da patologia é unicamente cirúrgico 10 .…”