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Published on: April 17, 2020
Clinical comparison between thoracoscopic and thoracotomy repair of Gross type C esophageal atresia
Shen Yang1, Peize Wang1, Zhi Yang2
1Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, China.
Insights
Thoracoscopic surgery for esophageal atresia and tracheoesophageal fistula is safe and effective. This minimally invasive approach shows comparable outcomes to thoracotomy, making it a viable option for Gross type C cases.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Anomalies
Background:
- Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are congenital conditions requiring surgical intervention.
- Gross type C represents a specific anatomical classification of EA/TEF.
- Surgical approach (thoracoscopic vs. thoracotomy) impacts clinical outcomes.
Purpose of the Study:
- To compare clinical outcomes of thoracoscopic surgery versus thoracotomy in patients with Gross type C EA/TEF.
- To evaluate perioperative factors and postoperative complications associated with each surgical approach.
- To determine the safety and efficacy of minimally invasive thoracoscopy for this condition.
Main Methods:
- Retrospective analysis of 190 patients with Gross type C EA/TEF (2007-2020).
- Patients divided into thoracoscopic (n=62) and thoracotomy (n=128) groups.
- Comparison of perioperative factors and postoperative complications.
Main Results:
- Statistically significant differences observed in associated anomalies, fistula closure, ventilation duration, feeding, pneumothorax management, and prognosis (P<0.05).
- Thoracoscopy showed a trend towards reduced anastomotic leakage but increased stricture incidence.
- No significant differences in operative time, pneumothorax, anastomotic leakage, stricture, or recurrent TEF between groups (P>0.05).
Conclusions:
- Thoracoscopic surgery is a safe and effective minimally invasive technique for Gross type C EA/TEF.
- It offers comparable operative times and postoperative complication rates to thoracotomy.
- Minimally invasive thoracoscopy is a viable surgical option for these complex congenital anomalies.
Background:
To compare the clinical outcomes between thoracoscopic approach and thoracotomy surgery in patients with Gross type C Esophageal atresia (EA) and tracheoesophageal fistula (TEF).
Methods:
Patients with Gross type C EA/TEF who underwent surgery from January 2007 to January 2020 at Beijing Children's Hospital were retrospectively analyzed. The patients were divided into two groups according to surgical approaches. The perioperative factors and postoperative complications were compared among the two groups.
Results:
One hundred and ninety patients (132 boys and 58 girls) with a median birth weight of 2975 (2600, 3200) g were included. The primary operations were performed via thoracoscopic (n = 62) and thoracotomy (n = 128) approach. After comparison of clinical characteristics between the two groups, we found that there were statistically significant differences in associated anomalies, method of fistula closure, duration of mechanical ventilation after surgery, feeding option before discharge, management of pneumothorax, and prognosis (all P < 0.05). To a certain extent, thoracoscopic surgery reduced the incidence of anastomotic leakage and increased the incidence of anastomotic stricture in this study. However, there were no statistically significant differences between the two groups in terms of operative time, postoperative pneumothorax, anastomotic leakage, anastomotic stricture, and recurrent tracheoesophageal fistula (all P > 0.05).
Conclusions:
Thoracoscopy surgery for Gross type C EA/TEF is a safe and effective, minimally invasive technique with comparable operative time and incidence of postoperative complications.
