Thoracoscopy or Thoracotomy for Esophageal Atresia

Abstract

Objective: This systematic review with meta-analysis compares health-and provider-based outcomes of thoracoscopic to thoracotomy repair of esophageal atresia. Summary of Background Data: Thoracoscopic surgery has become a routine operation for esophageal atresia repair. However, large studies comparing the safety and efficacy of thoracoscopy to thoracotomy are scarce. Current reviews are obscured with institutional experiences or pool small samples. Methods: PRISMA-compliant search in Medline/PubMed, EMBASE, Web of Science, and Cochrane Library (PROSPERO #CRD42019121862) for original studies comparing thoracoscopy to thoracotomy for esophageal atresia. Quality assessments were performed using the Joanna Briggs Institute Critical Appraisal Tool. Meta-analyses were presented as odds ratios and standardized mean differences. Results: This is the largest published meta-analysis, including 17 studies and 1043 patients. Thoracoscopy produce shorter hospital stay [standardized mean differences (SMD) À11.91; 95% confidence interval (CI) 23.49-6.10; P ¼ 0.0440], time until extubation (SMD À3.22; 95% CI 5.93-0.51; P ¼ 0.0198), time until first oral feeding (SMD À2.84; 95% CI 4.62-1.07; P ¼ 0.0017), and fewer musculoskeletal complications [odds ratio (OR) 0.08; 95% CI 0.01-0.58; P ¼ 0.0133). Thoracoscopy is as safe as thoracotomy regarding leakage (OR À1.92; 95% CI 0.97-3.80; P ¼ 0.0622), stricture formation (OR 2.66; 95% CI 0.86-3.23; P ¼ 0.1339), stricture dilatation (OR 1.90; 95% CI 0.16-3.88; P ¼ 0.0767), and mortality (OR 1.18; 95% CI 0.34-4.16; P ¼ 0.7934). However, thoracoscopy take longer (SMD þ27.69; 95% CI 12.06-43.32; P ¼ 0.0005) and necessitate more antireflux surgery (OR 2.12; 95% CI 1.06-4.24; P ¼ 0.0343). Conclusion: Thoracoscopy is effective and safe, with similar or better outcomes than thoracotomy for patients and providers. The only significant drawback is the need for antireflux surgery in the first years of life. Comparative randomized long-term studies are needed.

Retrospective Analysis of Pneumothorax After Repair of Esophageal Atresia/Tracheoesophageal Fistula: A Case Control Study

“…Anastomotic leakage, as one of the complications with a high incidence after EA/TEF repair [14], is closely related to pneumothorax, and our data also supports this view. The clinical manifestations of anastomotic leakage are sometimes similar to pneumothorax, such as dyspnea and decreased blood oxygen, which can be identi ed by chest radiograph or esophagography.…”

Habitual physical activity in patients born with oesophageal atresia: a multicenter cross-sectional study and comparison to a healthy reference cohort matched for gender and age

“…According to a recent meta-analysis, thoracoscopic repair has a lower risk for musculoskeletal complications compared to thoracotomy [ 24 ], especially when compared to conventional non-muscle sparing lateral thoracotomy with serratus anterior muscle division [ 25 ]. In our cohort, one patient reported scapula winging, but no patient reported musculoskeletal complications causing a limitation to sports participation, even though the majority of patients had an open repair.…”

Prevalence of and Risk Factors for Sagittal Posture Abnormalities in Children Born With Esophageal Atresia: A Prospective Cohort Study

“…One important and controversial question in EA patients is the effects on outcomes of the surgical technique, such as thoracotomy, mini-invasive thoracotomy, or thoracoscopy. Although a “historical” thoracotomy that includes muscle and costal damage has a negative effect on thoracic development and scoliosis ( 14 , 18 ), the advantages of the thoracoscopic vs. mini-invasive thoracotomy in terms of orthopedic sequelae remain to be established. A systematic review of 25 recent studies ( 19 ) concluded that, when conducted by experienced surgeons, thoracoscopic repair is a safe and minimally invasive alternative to conventional open repair and may yield better results in appropriately selected patients.…”