Are Low Weight or Cardiopathy Contraindications for Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula?

Abstract

Background Thoracoscopic repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is becoming an increasingly widespread technique; there is still controversy about its indication in certain patients. Our objective is to analyze if potential risk factors such as major congenital heart disease (CHD) or low birth weight (LBW) are a limitation to this approach.

Methods Retrospective study (2017–2021) of patients with EA and distal TEF who underwent thoracoscopic repair were included. Patients with LBW less than 2,000 g or major CHD were compared with the rest.

Results Twenty-five patients underwent thoracoscopic surgery. Nine patients (36%) had major CHD. Five of them (20%) were LBW less than 2,000 g, and only 8% (2/25) presented both risk factors. There were no differences in terms of operative time, conversion rate, tolerance evaluated with gasometric parameters (pO₂, pCO₂, pH) or complications (anastomotic leak and stricture, both early or during follow-up) in patients with major CHD and LBW (1,473 ± 319 vs. 2,664 ± 402 g). One conversion to thoracotomy was performed in a neonate weighing 1,050 g due to anesthetic intolerance. There was no recurrence of TEF. One patient died at the age of 9 months, due to major uncorrectable heart disease.

Conclusion Thoracoscopic repair of EA/TEF is feasible technique in patients with CHD or LBW, with similar results to other patients. The complexity of this technique warrants individualizing the indication in each case.

Level of Evidence IV.

Keywords

thoracoscopic - esophageal atresia - congenital heart disease - low birth weight - newborn

Publikationsverlauf

Eingereicht: 04. Februar 2023

Angenommen: 11. April 2023

Accepted Manuscript online:
13. April 2023

Artikel online veröffentlicht:
19. Mai 2023

• References

• 1 Rothenberg S. Thoracoscopic repair of esophageal atresia and tracheo-esophageal fistula in neonates: the current state of the art. Pediatr Surg Int 2014; 30 (10) 979-985
• 2 Tanny SPT, King SK, Comella A. et al. Selective approach to preoperative echocardiography in esophageal atresia. Pediatr Surg Int 2021; 37 (04) 503-509
• 3 Way C, Wayne C, Grandpierre V, Harrison BJ, Travis N, Nasr A. Thoracoscopy vs. thoracotomy for the repair of esophageal atresia and tracheoesophageal fistula: a systematic review and meta-analysis. Pediatr Surg Int 2019; 35 (11) 1167-1184
• 4 Yang YF, Dong R, Zheng C. et al. Outcomes of thoracoscopy versus thoracotomy for esophageal atresia with tracheoesophageal fistula repair: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2016; 95 (30) e4428
• 5 Borruto FA, Impellizzeri P, Montalto AS. et al. Thoracoscopy versus thoracotomy for esophageal atresia and tracheoesophageal fistula repair: review of the literature and meta-analysis. Eur J Pediatr Surg 2012; 22 (06) 415-419
• 6 Broemling N, Campbell F. Anesthetic management of congenital tracheoesophageal fistula. Paediatr Anaesth 2011; 21 (11) 1092-1099
• 7 Krosnar S, Baxter A. Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: anesthetic and intensive care management of a series of eight neonates. Paediatr Anaesth 2005; 15 (07) 541-546
• 8 Ron O, De Coppi P, Pierro A. The surgical approach to esophageal atresia repair and the management of long-gap atresia: results of a survey. Semin Pediatr Surg 2009; 18 (01) 44-49
• 9 Fernandes E, Kusel A, Evans S, Houghton J, Hamill JK. Is thoracoscopic esophageal atresia repair safe in the presence of cardiac anomalies?. J Pediatr Surg 2020; 55 (08) 1511-1515
• 10 Ishimaru T, Fujiogi M, Michihata N. et al. Impact of congenital heart disease on outcomes after primary repair of esophageal atresia: a retrospective observational study using a nationwide database in Japan. Pediatr Surg Int 2019; 35 (10) 1077-1083
• 11 Rothenberg SS. Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula in neonates, first decade's experience. Dis Esophagus 2013; 26 (04) 359-364
• 12 Lal DR, Gadepalli SK, Downard CD. et al; Midwest Pediatric Surgery Consortium. Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2017; 52 (08) 1245-1251
• 13 Pini Prato A, Carlucci M, Bagolan P. et al. A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2015; 50 (09) 1441-1456
• 14 Lawal TA, Gosemann JH, Kuebler JF, Glüer S, Ure BM. Thoracoscopy versus thoracotomy improves midterm musculoskeletal status and cosmesis in infants and children. Ann Thorac Surg 2009; 87 (01) 224-228
• 15 Patkowsk D, Rysiakiewicz K, Jaworski W. et al. Thoracoscopic repair of tracheoesophageal fistula and esophageal atresia. J Laparoendosc Adv Surg Tech A 2009; 19 (Suppl. 01) S19-S22
• 16 van der Zee DC, Tytgat SHAJ, Zwaveling S, van Herwaarden MYA, Vieira-Travassos D. Learning curve of thoracoscopic repair of esophageal atresia. World J Surg 2012; 36 (09) 2093-2097
• 17 Dingemann C, Ure BM. Minimally invasive repair of esophageal atresia: an update. Eur J Pediatr Surg 2013; 23 (03) 198-203
• 18 Okuyama H, Saka R, Takama Y, Nomura M, Ueno T, Tazuke Y. Thoracoscopic repair of esophageal atresia. Surg Today 2020; 50 (09) 966-973
• 19 Wu Y, Kuang H, Lv T, Wu C. Comparison of clinical outcomes between open and thoracoscopic repair for esophageal atresia with tracheoesophageal fistula: a systematic review and meta-analysis. Pediatr Surg Int 2017; 33 (11) 1147-1157
• 20 Holcomb III GW. Thoracoscopic surgery for esophageal atresia. Pediatr Surg Int 2017; 33 (04) 475-481
• 21 Bishay M, Giacomello L, Retrosi G. et al. Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia: results of a pilot randomized controlled trial. Ann Surg 2013; 258 (06) 895-900
• 22 Son J, Jang Y, Kim W. et al. Thoracoscopic repair of esophageal atresia with distal tracheoesophageal fistula: is it a safe procedure in infants weighing less than 2000 g?. Surg Endosc 2021; 35 (04) 1597-1601
• 23 Iacona RV, Saxena AK. Thoracoscopic repair of esophageal atresia with distal tracheoesophageal fistula (type C): systematic review. Surg Laparosc Endosc Percutan Tech 2020; 30 (04) 388-393