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

Abstract

Is it outdated now to do a thoracotomy to repair esophageal atresia (EA)?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.

Postoperative Complications and Functional Outcome after Esophageal Atresia Repair: Results from Longitudinal Single-Center Follow-Up

“…44 Results published by surgeons who are pioneers in minimally invasive EA/TEF repair may not be generalizable and the complication rate from centers with less experience is likely underreported in the literature. 45 Furthermore, a recent randomized controlled trial reported that thoracoscopic EA/TEF repair can be associated with worse intraoperative acidosis and hypercapnia compared with open management. 46 However, in selected patients and with experienced teams, thoracoscopic correction of EA/TEF is appropriate.…”

Respiratory problems in children with esophageal atresia and tracheoesophageal fistula

“…Preserving the original esophagus is the most important priority and is achieved in 90% of all cases by primary anastomosis with closure of the esophago-tracheal fistula. Even if the preferred approach is through a right-sided thoracotomy [ 3 ], in the past 10 years, thoracoscopic repair has become standard in specialized centers also for the correction of congenital and acquired TEF. A recent meta-analysis has confirmed the effectiveness of this approach, which seems to have outcomes not different from those of open surgery [ 4 ].…”

Thoracoscopic Repair of Esophageal Atresia With Distal Fistula in a New Born: A Technical Case Report

“…(9) While thoracoscopic repair is apparently safe and possibly advantageous in some respects when performed by a handful of experts, it should not be touted as the 'gold standard' to be utilized by all pediatric surgeons. [8] We have used minimally invasive surgical techniques for many diseases into our experience. Now, the main aim of anyone technique is a good anastomosis, survival, limited sequels and good quality of life [9].…”