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Tracheoesophageal fistula in the developing world: are we ready for thoracoscopic repair?

Hossam S Alslaim1, Andrew B Banooni2, Ahmad Shaltaf3

  • 1Department of Surgery, Medical College of Georgia, Augusta, GA, USA.

Pediatric Surgery International
|March 29, 2020
PubMed

Insights

Management of newborns with tracheoesophageal fistula (TEF) in low- and middle-income countries (LMICs) presents challenges. Improving outcomes requires addressing diagnostic, operative, and post-operative care, with gradual implementation of advanced thoracoscopy where feasible.

Area of Science:

  • Pediatric Surgery
  • Neonatal Care
  • Global Health

Background:

  • Tracheoesophageal fistula (TEF) is a critical indicator of neonatal care capacity in developing nations.
  • Effective management of TEF in low- and middle-income countries (LMICs) is essential for improving infant survival rates.

Purpose of the Study:

  • To review the literature on TEF management in LMICs.
  • To identify challenges in diagnostic, operative, and post-operative care for TEF patients in LMICs.
  • To explore approaches for improving outcomes, including the potential for thoracoscopic repair.

Main Methods:

  • Systematic review of English literature focusing on TEF management in LMICs.
  • Assessment of challenges in all stages of TEF patient care.
  • Evaluation of existing literature on thoracoscopic repair in developing countries.

Main Results:

  • Surgical outcomes in LMICs are comparable to developed nations, but secondary complications like sepsis and pneumonia are more frequent.
  • Staged repair is common, with limited use of thoracoscopic techniques.
  • Resource limitations significantly impact intraoperative and post-operative management.

Conclusions:

  • While not universally applicable, gradual implementation of advanced thoracoscopy should be considered in LMICs.
  • Assessing existing capabilities is crucial before introducing advanced procedures.
  • Tailored strategies are needed to enhance TEF care in resource-limited settings.
Abstract

Keywords:
Global healthMinimally invasive surgeryNeonatal anesthesiaNeonatal surgeryThoracoscopy

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