Systematic Review of the Literature: Comparison of Open and Minimal Access Surgery (Thoracoscopic Repair) of Esophageal Atresia with Tracheo-Esophageal Fistula (EA-TEF)

Oomen, Matthijs W.N.

doi:10.5772/32537

Cited by 3 publications

(5 citation statements)

References 40 publications

(49 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent comparative review of open and thoracoscopic EA repairs demonstrated an optimistic 9% stricture rate for the minimally invasive approach, 16 although more contemporary series have documented stricture rates that approach the open rate (►Table 3). A systematic review comparing open to thoracoscopic repair also demonstrated a wide variation in AS, from 9 to 45% after thoracoscopy (defining AS as requiring > 1 dilatation) and from 4.3 to 60% after thoracotomy (variable definition of AS) 17 ; the author concluded that the incidence of AS was comparable between the two approaches and that a clear definition of AS would be important.…”

Section: Introductionmentioning

confidence: 99%

Anastomotic Stricture after Esophageal Atresia Repair: A Critical Review of Recent Literature

2013

View full text Add to dashboard Cite

Anastomotic strictures (ASs) complicate the postoperative course of roughly one-third of all patients with esophageal atresia with or without tracheoesophageal fistula. Its development is multifactorial, but is due in part to tension on the anastomosis, gastroesophageal reflux disease, and the presence of a leak in the early postoperative period. Efforts at reducing the rate of AS have been largely unsuccessful, although meticulous technique and aggressive acid suppression remain the cornerstones of perioperative care. Once an AS has been confirmed, the first-line treatment remains a course of esophageal dilatation. Adjuncts to dilatation are frequently required, including steroid injection or the topical application of mitomycin C. Currently, there is insufficient evidence to promote one at the expense of the other. Esophageal stenting has recently been added to the algorithm of treatment, although additional literature is required to confirm its safety and efficacy. Finally, stricture resection followed by primary esophageal anastomosis or, rarely, esophageal replacement with an interposition graft remain options for AS refractory to all other forms of treatment.

show abstract

Section: Introductionmentioning

confidence: 99%

Anastomotic Stricture after Esophageal Atresia Repair: A Critical Review of Recent Literature

2013

View full text Add to dashboard Cite

show abstract

“…Esophageal stricture remains the most frequent complication after esophageal atresia (EA) repair despite refinements in operative techniques. Between 8% and 49% of children with EA will develop an anastomotic stricture requiring at least one dilatation . EA is the leading cause of benign esophageal stricture in children.…”

mentioning

confidence: 99%

“…Between 8% and 49% of children with EA will develop an anastomotic stricture requiring at least one dilatation. [1][2][3][4][5][6] EA is the leading cause of benign esophageal stricture in children. Predisposing factors have been identified including the type of anastomosis, the type of suture material, the degree of tension of the anastomosis, the length of the gap, and the occurrence of a leak at the anastomosis.…”

mentioning

confidence: 99%

Refractory strictures post-esophageal atresia repair: what are the alternatives?

2013

View full text Add to dashboard Cite

Esophageal strictures remain the most frequent complication after esophageal atresia (EA) repair despite refinements in operative techniques. With an incidence of anastomotic stricture between 8% and 49%, EA is the most frequent cause of benign esophageal stricture in children. The mainstay of treatment for esophageal stricture is dilatation with a 58-96% success rate. In order to relieve dysphagia, between 1 and 15 dilatations will be required in each EA patient with an esophageal stricture. However dilatations may lead to complications including perforation (0.1-0.4% of all esophageal benign strictures) and sociopsychological morbidity. Fifty percent of EA strictures will improve in 6 months. However, 30% will persist and require repeat dilatations. The present article explores the variety of non-surgical alternative treatments for anastomotic strictures after EA repair, focusing on triamcinolone acetonide, mitomycin C and esophageal stents. We propose an algorithm for a more standardized therapeutic approach, with the hope that an international panel of experts could meet and establish a consensus.

show abstract

“…Along with Holcomb et al . in 2005, he concludes stating the need for more prospective, properly designed studies . Because randomized, controlled studies will be very difficult to perform, perhaps registry‐based, multicenter, comparative studies on EA repair methodologies and outcomes will provide important answers.…”

Section: Discussionmentioning

confidence: 99%

“…How many patients will suffer serious, avoidable complications, or mortality while the teams will go through their learning curves, mostly to minimize the scar? 29 Because randomized, controlled studies will be very difficult to perform, perhaps registry-based, multicenter, comparative studies on EA repair methodologies and outcomes will provide important answers.…”

Section: Learning Curvementioning

confidence: 99%

Thoracotomy for repair of esophageal atresia: not as bad as they want you to think!

Laberge

Blair

2013

Dis Esophagus

View full text Add to dashboard Cite

Is it outdated now to do a thoracotomy to repair esophageal atresia (EA)? Our practices and the literature on the subject of thoracoscopic and open thoracotomy repair of EA were reviewed, seeking answers to the following questions: Is it correct to compare the new thoracoscopic approach for the repair of EA against the thoracotomy techniques of 15-30 years ago? Should post-thoracotomy scoliosis/thoracic deformity reported in up to 56% of patients be a significant current concern? Are the clips used to close the fistula in thoracoscopic repairs as safe as open suture closures? Is the leak and stricture rate similar with thoracoscopic surgery? Are the anesthesia, period of ventilation, pain, time to first feeding, and the length of hospital stay significantly different with current thoracotomy techniques compared with thoracoscopic methods? Is the cosmetic result of a thoracoscopic repair significantly better? Is the learning curve for EA thoracoscopic repair harming patients for minimal long-term benefit? These questions were scientifically unanswerable at this time. The limited EA thoracotomies currently performed have a track record of proven safety and minimal morbidity. The results published by surgeons who are pioneers in thoracoscopy may not be generalizable, and the complication rate from teams with less experience is likely underreported. In selected patients and with experienced teams, thoracoscopic EA repair is appropriate. However, EA repair via thoracotomy should, for now, remain as the 'gold standard'. Further registry-based, multicenter, comparative studies on EA repair methodologies and outcomes should provide important answers.

show abstract

Systematic Review of the Literature: Comparison of Open and Minimal Access Surgery (Thoracoscopic Repair) of Esophageal Atresia with Tracheo-Esophageal Fistula (EA-TEF)

Cited by 3 publications

References 40 publications

Anastomotic Stricture after Esophageal Atresia Repair: A Critical Review of Recent Literature

Anastomotic Stricture after Esophageal Atresia Repair: A Critical Review of Recent Literature

Refractory strictures post-esophageal atresia repair: what are the alternatives?

Thoracotomy for repair of esophageal atresia: not as bad as they want you to think!

Contact Info

Product

Resources

About