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Exploration of the thoracoscopic treatment of esophageal atresia under high-frequency ventilation

Chao Zheng1,2, Yu Lin1,2, Yuanbin He1,2

  • 1Department of Pediatric Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), Fuzhou, China.

Frontiers in Pediatrics
|April 20, 2023
PubMed

Insights

Thoracoscopic esophageal atresia repair is feasible with high-frequency oscillatory ventilation (HFOV), showing shorter operation times. This approach benefits patients with complex conditions, though long-term outcomes require further investigation.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Esophageal atresia (EA) repair presents surgical challenges, particularly in neonates with comorbidities.
  • High-frequency oscillatory ventilation (HFOV) is used in pediatric respiratory distress but its role during EA surgery is less defined.

Purpose of the Study:

  • To evaluate the feasibility and safety of thoracoscopic EA repair performed under HFOV.
  • To compare surgical outcomes between EA repair with and without HFOV.

Main Methods:

  • A single-center retrospective analysis of 24 children undergoing EA repair.
  • Patients were divided into HFOV and non-HFOV groups.
  • Demographic data, surgical results, and complications were analyzed.

Main Results:

  • Thoracoscopic EA repair under HFOV was feasible, with a mean operative time of 165.8 minutes.
  • Postoperative complications included two cases of anastomotic leakage and one recurrent tracheoesophageal fistula, all managed conservatively.
  • Mean mechanical ventilation time was 8.83 days; no significant differences were found between groups except for shorter operative time in the HFOV group.

Conclusions:

  • Thoracoscopic EA anastomosis under HFOV is feasible, especially for patients with severe pulmonary infections, cardiac malformations, or poor anesthesia tolerance.
  • While short-term outcomes appear favorable, long-term prognosis necessitates further large-scale studies.
Abstract

Keywords:
HFOVendoscopicesophageal atresiahigh-frequency oscillatory ventilationthoracoscopy

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