Short-term and mid-term effects of thoracoscopic repair of esophageal atresia: No anastomotic leaks or conversions to open technique

Abstract

The frequency rate of esophageal anastomosis leaks after thoracoscopic correction of esophageal atresia (EA) in the current literature is reported as 5.6%–24.7% and a conversion rate of 2%–53%. The objective of this retrospective study was to examine the characteristics of EA and analysis of the safety and efficacy of EA repair with the use of the thoracoscopic approach in a single academic center, as well as risk factors analysis in the context of short-term and mid-term follow-up status. A retrospective analysis of the management of all consecutive newborns affected by EA hospitalized in our department over a period between 2013 and 2022, including preoperative, perioperative, and postoperative management, together with the outcome, complications and long-term follow-up status was performed. A total of 38 patients with a median birth weight of 2,570 g (range; 1,020–3,880) were treated over the study period, including 30/38 (78.9%) with additional congenital anomalies. Overall, 30 patients underwent primary anastomosis of the esophagus and eight underwent a multistaged procedure, with or without an initial ligation of the tracheoesophageal fistula and delayed primary anastomosis. Overall survival for all patients was 0.894 ± 0.050, with a median follow-up of 4.5 years. We noted neither anastomotic leaks nor conversions to open technique in our cohort. Implementation of vancomycin prophylaxis was successful in preventing postoperative central venous access-related infectious complications. At the end of the follow-up, 85% of patients have a Lansky performance score ≥80. Risk factors analysis for length of hospitalization, overall survival, Lansky performance status, and neurological impairment were analyzed. In conclusion, we have found that the outcome of thoracoscopic repair of EA in terms of surgery-dependent morbidity (anastomosis leakage, conversion rate to open surgery), provides benefit to those previously reported in the literature, regardless of the prognostic criteria of the classification system.

Thoracoscopic primary repair of esophageal atresia and tracheoesophageal fistula: Our early experience

“…Preoperative ventilator dependence is an additional prognostic factor independent of the associated anomalies. These factors may have a more significant impact on survival than body weight [20]. In our study, 25% of cases needed mechanical ventilation before operation.…”

“…The literature review conducted by Okuyama et al [10] reported an anastomotic leakage rate ranging from 0 to 20%. A variety of factors can contribute to the leakage, such as excessive mobilization of the distal end of the esophagus, esophageal injury, poor suturing technique, anastomotic tension, the use of inappropriate sutures, associated ischemia, a long gap length or sepsis [20].…”

“…However, it should be noted that the stricture can also manifest more than one year after the surgery. According to Galazka et al [20], 15% of patients had such severe GERD that they required an anti-reflux procedure called Nissen fundoplication. During our study, we observed one instance of gastroesophageal reflux that did not require surgical intervention and another case of anastomotic stenosis that required one session of endoscopic dilatation.…”

Prenatal diagnosis of interrupted aortic arch and oesophageal atresia – monitoring and postnatal management with positive outcome – case report

“…Cases of patients with oesophageal atresia with CHD are usually treated by thoracotomy [10], but in this instance it was possible to treat it with thoracoscopy [11][12][13][14].…”

Atresia esofágica. Caso clínico

“…Esta última modalidad es la más utilizada en la actualidad a nivel global por las ventajas que aporta tanto para el paciente como para el cirujano: permite una amplia visualización del campo quirúrgico, elimina la morbilidad neonatal de la toracotomía tales como escoliosis, escápula alada, dolor crónico, debilidad del hombro, asimetría de la pared torácica; además, cabe destacar que permite lograr también resultados estéticos satisfactorios. (26) 4. CONCLUSIONES Los resultados en cuanto al abordaje y tratamiento de la atresia esofágica han mejorado considerablemente en las últimas décadas y en la actualidad la supervivencia a nivel mundial, sobre todo en países desarrollados, es del 90% e incluso superior en algunas regiones.…”