Thoracotomy vs. Thoracoscopy for Esophageal Atresia with Tracheoesophageal Fistula Repair: Is There a Difference in Quality of Life?

Abstract

Aim: Esophageal atresia (EA) is the most common congenital esophageal malformation. Thoracoscopic repair is gaining popularity, but controversy persists regarding the ideal surgical approach for this challenging anomaly. This study’s aim is to analyze outcomes in terms of quality of life (QoL) of children undergoing thoracotomy and thoracoscopy for type III EA repair. Methods: Perinatal characteristics, malformations, surgical procedures, complications, gastrointestinal, and respiratory current symptoms were collected. QoL was investigated through Esophageal-Atresia-QoL (EAQoL) and Pediatric-QoL (PedsQL) 4.0 standardized and validated questionnaires. Statistical Mann–Whitney test with significance level p < 0.05 was carried out. Main results: A total of 32 patients undergoing type III EA primary repair answered the questionnaire, including 17 thoracotomy and 15 thoracoscopy. Median birth weight was not significantly different between two groups (median [2.385; 2.475], p = 0.3529) while gestational age showed statistically difference (median [36; 38], p = 0.0063). Thirty-five associated malformations (15 thoracotomy, 20 thoracoscopy) in 23 patients were observed. Postoperative complications occurred in nine patients in the thoracotomy group (one recurrent fistula, two leakages, six stenosis) and in six patients in the thoracoscopic group (two recurrent fistula, four stenosis). Analyzing EAQoL, we found statistically significant difference in physical health between the two groups (median [83; 96], p = 0.0119), while there was no difference in social relations, eating, and total score (median [100; 100], p = 0.3473) (median [91; 97], p = 0.5749) (median [91; 96], p = 0.1710). Investigating PedsQL, psychosocial health score (median [88; 98], p = 0.0069), and total score (median [91;99], p = 0.0043) were statically significant different between the groups, whereas there was no difference for physical health score (median [91; 100], p = 0.0706). Conclusions: Thoracoscopic EA repair is safe and feasible, allowing patient to have a better QoL in terms of physical and psychosocial health score.