Thoracoscopic repair of esophageal atresia with a distal fistula - lessons from the first 10 operations.

Abstract

IntroductionThoracoscopic esophageal atresia (EA) repair was first performed in 1999, but still the technique is treated as one of the most complex pediatric surgical procedures.AimThe study presents a single-center experience and learning curve of thoracoscopic repair of esophageal atresia and tracheo-esophageal (distal) fistula.Material and methodsFrom 2012 to 2014, 10 consecutive patients with esophageal atresia and tracheo-esophageal fistula were treated thoracoscopically in our center. There were 8 girls and 2 boys. Mean gestational age was 36.5 weeks and mean weight was 2230 g. Four children had associated anomalies. The surgery was performed after stabilization of the patient between the first and fourth day after birth. Five patients required intubation before surgery for respiratory distress. Bronchoscopy was not performed before the operation.ResultsIn 8 patients, the endoscopic approach was successfully used thoracoscopically, while in 2 patients conversion to an open thoracotomy was necessary. In all patients except 1, the anastomosis was patent, with no evidence of leak. One patient demonstrated a leak, which did not resolve spontaneously, necessitating surgical repair. In long-term follow-up, 1 patient required esophageal dilatation of the anastomosis. All patients are on full oral feeding.ConclusionsThe endoscopic approach is the method of choice for the treatment of esophageal atresia in our center because of excellent visualization and precise atraumatic preparation even in neonates below a weight of 2000 g.

Learning curve for the thoracoscopic repair of esophageal atresia with tracheoesophageal fistula

“…Our analysis clearly showed a learning curve that fit a logarithmic function curve well, which seems to be reasonable for the learning curve analysis for all other types of surgical skills. Nachulewicz et al reported that the learning curve was obviously visible in eight successive cases, although the duration of the operation did not diminish markedly . Lee et al also showed that the initial period of the learning curve was evident in their earlier 13 cases of thoracoscopic EA/TEF repair .…”