1
|
Hyman SC, Patwardhan U, West E, Schermerhorn S, Lee J, Gollin G. Outcomes After Thoracoscopic and Open Repair of Esophageal Atresia With Tracheoesophageal Fistula at US Children's Hospitals. J Pediatr Surg 2025; 60:162148. [PMID: 39793533 DOI: 10.1016/j.jpedsurg.2024.162148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 12/14/2024] [Accepted: 12/24/2024] [Indexed: 01/13/2025]
Abstract
BACKGROUND Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) has been reported to have superior outcomes to the open approach. We sought to evaluate adoption of thoracoscopic repair at US children's hospitals and compare outcomes to open repair. METHODS The Pediatric Health Information System database was used to identify patients with EA/TEF who underwent repair between 2016 and 2023. Patients with birthweight less than 1800g and/or repair after the first 3 days of life were excluded. Postoperative complications, length of stay, and opioid requirements were assessed. RESULTS Inclusion criteria were met in 618 patients. Eighty thoracoscopic repairs were reported (13 %). The proportion of thoracoscopic operations did not change over the study period. Infants managed with a thoracoscopic or open approach were demographically similar. Thoracoscopic repair was associated with a higher incidence of anastomotic stricture (39 % vs. 26 %, p = 0.02), recurrent laryngeal nerve (RLN) injury (11 % vs 3 %, p = 0.001), and fewer days of postoperative opioid (5.2 vs. 6.5, p = 0.04). Other operative complications, LOS, and duration of TPN did not differ based on operative approach. CONCLUSION A small proportion of EA/TEF repairs in US children's hospitals were completed thoracoscopically and adoption of this approach did not increase between 2016 and 2023. Anastomotic stricture and RLN injury were significantly more likely after thoracoscopic repair. Although opioids were administered for one day fewer after thoracoscopic operations, no other metrics favored this approach. These data contrast with recent literature and suggest that the experience of high-volume hospitals may underestimate the morbidity of thoracoscopic EA/TEF repair and overestimate its benefits. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
- Simone Carlson Hyman
- University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Utsav Patwardhan
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| | - Erin West
- Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| | - Sophia Schermerhorn
- Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| | - Joseph Lee
- Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| | - Gerald Gollin
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| |
Collapse
|
2
|
van Hal AFRL, Vlot J, van Rosmalen J, Wijnen RMH, van Gils-Frijters APJM, Gischler SJ, Staals LM, IJsselstijn H, Rietman AB. Minimally invasive surgical approach in children treated for oesophageal atresia is associated with attention problems at school age: a prospective cohort study. Eur J Pediatr 2024; 183:2131-2140. [PMID: 38363392 PMCID: PMC11035457 DOI: 10.1007/s00431-024-05449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/17/2024]
Abstract
The long-term neurodevelopment of children born with oesophageal atresia (OA) is unclear. Therefore, we assessed the neurocognitive domains and their predictors. Patients born with OA between February 2006 and December 2014, who were routinely seen at eight years as part of a structured prospective longitudinal follow-up program, were included. Main outcome measures were need for school support, performance in various neurocognitive domains and potential predictors of neurocognitive problems. We analysed data of 65 children with a mean (SD) age of 8.1 (0.2) years, of whom 89% with OA type C. Thirty-five (54%) surgical corrections were minimally invasive; the median (interquartile range) duration of exposure to anaesthetics in the first 24 months was 398 (296 - 710) minutes. Forty-four (68%) attended regular education without extra support and intelligence was within normal range (99-108). More than 50% had z-scores ≤ -2 on one or more neurocognitive domains, of which attention was the most frequently affected domain. The speed on the sustained attention task was significantly below normal (z-score -1.48 (2.12), p < .001), as was fluctuation of sustained attention (z-score -3.19 (3.80), p < .001). The minimally invasive approach and a lower socio-economic status (both p = 0.006) proved significant predictors for sustained attention problems in multivariable analyses. Conclusion: Children who undergo minimally invasive surgery for OA correction are at risk for sustained attention problems at school age. Future studies unravelling the effects of perioperative events on neurodevelopment should lead to optimal surgical, anaesthesiological, and intensive care management in the neonatal period. What is Known: • School-aged children born with oesophageal atresia have normal intelligence but problems with sustained attention at eight years. What is New: • Oesophageal atresia patients, who undergo minimally invasive surgery or who have a background of lower socioeconomic status are at serious risk for sustained attention problems at school age. • Moreover, those who have been intubated for a longer period are at risk for stronger fluctuations in sustained attention.
Collapse
Affiliation(s)
- Anne-Fleur R L van Hal
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - John Vlot
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Annabel P J M van Gils-Frijters
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Saskia J Gischler
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lonneke M Staals
- Department of Anaesthesiology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - André B Rietman
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Prasad G, Singh A, Kainth D, Khanna P, Anand S. Intraoperative Regional Cerebral Oxygenation During Pediatric Thoracoscopic Surgery: A Systematic Review. J Laparoendosc Adv Surg Tech A 2024; 34:274-279. [PMID: 37862569 DOI: 10.1089/lap.2023.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Background: Ventilating a pediatric patient during thoracoscopy is challenging. Few studies have highlighted the impact of capnothorax in children by measuring regional cerebral oxygen saturation (rcSO2) with near infrared spectroscopy. In this systematic review, we aimed to summarize the data from relevant studies and assess whether thoracoscopy in children is associated with intraoperative pathological cerebral desaturation. Methods: The authors systematically searched four databases for relevant studies on the measurement of rcSO2 during pediatric thoracoscopic procedures. The primary outcome was the proportion of patients with pathological desaturation, that is, >20% decline in the intraoperative rcSO2. Risk of bias among the included studies was estimated using the Newcastle-Ottawa scale. Results: The systematic search resulted in 776 articles, of which 7 studies were included in the analysis. In total, 88 patients (99 procedures) with an age ranging from 0 days to 8.1 years were included. Of these, 43 (49%) patients were neonates. The included cohort had esophageal atresia and tracheoesophageal fistula (n = 26), long-gap esophageal atresia (n = 5), congenital diaphragmatic hernia (n = 14), and congenital pulmonary airway malformations and other conditions needing lung resection (n = 43). Of the total 99 procedures, pathological desaturation was noticed in 13 (13.1%, 95% confidence interval 7.2-21.4) of them. Upon quality assessment, most of the studies were weaker in the selection and comparability domains. Conclusion: In this review, pathological cerebral desaturation was noticed in 13.1% of the pediatric thoracoscopic procedures. However, due to limited methodological quality of the included studies, further randomized multicentric studies comparing rcSO2 in open versus thoracoscopic surgeries are needed to derive definitive conclusions.
Collapse
Affiliation(s)
- Gaurav Prasad
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Apoorv Singh
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepika Kainth
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
4
|
Flaherty E, Folaranmi SE. Thoracoscopic Versus Open Repair of Esophageal Atresia: A Systematic Review of Surgical Outcomes. J Laparoendosc Adv Surg Tech A 2023; 33:1114-1120. [PMID: 37418028 DOI: 10.1089/lap.2022.0561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Introduction: Esophageal atresia (EA) is a rare defect in the continuity of the esophagus, with the absent portion forming an upper and lower segment. Despite both thoracoscopic and conventional open repair (OR) techniques being well established worldwide, the literature remains unclear as to the comparison of surgical outcomes and efficacy of each procedure. Aim: To conduct a systematic review to determine which technique for EA repair, thoracoscopic or open, has the better outcome. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant literature search returned 14 full text articles for analysis of demographic information and surgical outcomes. Results: Major comorbidities were more likely in the OR group (P < .05) with all other surgical outcomes comparable between the two groups. Conclusion: Overall, this systematic review highlights that the surgical outcomes of patients undergoing thoracoscopic repair for EA are comparable with those of the conventional OR.
Collapse
Affiliation(s)
- Erin Flaherty
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Semiu Eniola Folaranmi
- School of Medicine, Cardiff University, Cardiff, United Kingdom
- Department of Paediatric Surgery, Children's Hospital for Wales, Cardiff, United Kingdom
| |
Collapse
|
5
|
Koga H, Miyano G, Ochi T, Seo S, Miyake Y, Yazaki Y, Lane GJ, Kataoka K, Nishimura K, Yamataka A. Intraoperative Bronchoscopic Inspection Facilitates Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula. J Laparoendosc Adv Surg Tech A 2023; 33:291-295. [PMID: 36735541 DOI: 10.1089/lap.2022.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Aim: The value of intraoperative bronchoscopic inspection (IBI) for accurate confirmation of the location and distance between the distal tracheoesophageal fistula (TEF) and the proximal blind end of the esophagus (GAP) was evaluated in Type C esophageal atresia (EA)+TEF. Methods: IBI involved inserting the tip of a bronchoscope into the TEF and a nasogastric tube into the blind end of the EA and measuring GAP with fluoroscopy. EA+TEF patients (n = 23) treated thoracoscopically between 2007 and 2020 were classified according to IBI as IBI+ (n = 16) and IBI- (n = 7) to compare demographics, operative time, and time taken for TEF division. Results: Demographics were similar. Mean time for TEF division (15.4 ± 4.6 minutes for IBI+ versus 38.6 ± 20.9 minutes for IBI-; p < .05) and mean operative time (215.3 ± 48.9 minutes for IBI+ versus 286.4 ± 51.7 minutes for IBI+; p < .05) were significantly shorter. Mean GAP measured radiographically was 0.5 cm (range: 0-1.2 cm); mean GAP measured with IBI was 0.9 cm (range: 0-2.2 cm). Postoperative complications were 3 anastomotic leakages (1/16 in IBI+ and 2/7 in IBI-) that resolved without surgery and 8 strictures (3/16 in IBI+ and 5/7 in IBI-) treated by dilatation. Conclusions: IBI was effective for measuring GAP and is recommended for improving the efficiency of thoracoscopic repair.
Collapse
Affiliation(s)
- Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shogo Seo
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuichiro Miyake
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuta Yazaki
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kumi Kataoka
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kinya Nishimura
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
6
|
Marquart JP, Bowder AN, Bence CM, St Peter SD, Gadepalli SK, Sato TT, Szabo A, Minneci PC, Hirschl RB, Rymeski BA, Downard CD, Markel TA, Deans KJ, Fallat ME, Fraser JD, Grabowski JE, Helmrath MA, Kabre RD, Kohler JE, Landman MP, Lawrence AE, Leys CM, Mak GZ, Port E, Saito J, Silverberg J, Slidell MB, Wright TN, Lal DR. Thoracoscopy versus thoracotomy for esophageal atresia and tracheoesophageal fistula: Outcomes from the Midwest Pediatric Surgery Consortium. J Pediatr Surg 2023; 58:27-33. [PMID: 36283849 DOI: 10.1016/j.jpedsurg.2022.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND/PURPOSE Controversy persists regarding the ideal surgical approach for repair of esophageal atresia with tracheoesophageal fistula (EA/TEF). We examined complications and outcomes of infants undergoing thoracoscopy and thoracotomy for repair of Type C EA/TEF using propensity score-based overlap weights to minimize the effects of selection bias. METHODS Secondary analysis of two databases from multicenter retrospective and prospective studies examining outcomes of infants with proximal EA and distal TEF who underwent repair at 11 institutions was performed based on surgical approach. Regression analysis using propensity score-based overlap weights was utilized to evaluate outcomes of patients undergoing thoracotomy or thoracoscopy for Type C EA/TEF repair. RESULTS Of 504 patients included, 448 (89%) underwent thoracotomy and 56 (11%) thoracoscopy. Patients undergoing thoracoscopy were more likely to be full term (37.9 vs. 36.3 weeks estimated gestational age, p < 0.001), have a higher weight at operative repair (2.9 vs. 2.6 kg, p < 0.001), and less likely to have congenital heart disease (16% vs. 39%, p < 0.001). Postoperative stricture rate did not differ by approach, 29 (52%) thoracoscopy and 198 (44%) thoracotomy (p = 0.42). Similarly, there was no significant difference in time from surgery to stricture formation (p > 0.26). Regression analysis using propensity score-based overlap weighting found no significant difference in the odds of vocal cord paresis or paralysis (OR 1.087 p = 0.885), odds of anastomotic leak (OR 1.683 p = 0.123), the hazard of time to anastomotic stricture (HR 1.204 p = 0.378), or the number of dilations (IRR 1.182 p = 0.519) between thoracoscopy and thoracotomy. CONCLUSION Infants undergoing thoracoscopic repair of Type C EA/TEF are more commonly full term, with higher weight at repair, and without congenital heart disease as compared to infants repaired via thoracotomy. Utilizing propensity score-based overlap weighting to minimize the effects of selection bias, we found no significant difference in complications based on surgical approach. However, our study may be underpowered to detect such outcome differences owing to the small number of infants undergoing thoracoscopic repair. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- John P Marquart
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA.
| | - Alexis N Bowder
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA
| | - Christina M Bence
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA
| | - Shawn D St Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Thomas T Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA
| | - Aniko Szabo
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43206, USA
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Beth A Rymeski
- Department of Pediatric Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave, ML 2023, Cincinnati, OH 45229, USA
| | - Cynthia D Downard
- Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, 530 S. Jackson St, Louisville, KY 40202, USA
| | - Troy A Markel
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall, Indianapolis, IN 46202, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43206, USA
| | - Mary E Fallat
- Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, 530 S. Jackson St, Louisville, KY 40202, USA
| | - Jason D Fraser
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Julia E Grabowski
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611, USA
| | - Michael A Helmrath
- Department of Pediatric Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave, ML 2023, Cincinnati, OH 45229, USA
| | - Rashmi D Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611, USA
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall, Indianapolis, IN 46202, USA
| | - Amy E Lawrence
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43206, USA
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA
| | - Grace Z Mak
- The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL, USA
| | - Elissa Port
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611, USA
| | - Jacqueline Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, Suite 5S40-Campus Box 8235, One Children's Place, St. Louis, MO 63110, USA
| | - Jared Silverberg
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Mark B Slidell
- The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL, USA
| | - Tiffany N Wright
- Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, 530 S. Jackson St, Louisville, KY 40202, USA
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA
| | | |
Collapse
|
7
|
Zhao J, Yang S, Li S, Wang P, Zhang Y, Zhao Y, Hua K, Gu Y, Liao J, Li S, Chen Y, Huang J. Retrospective analysis of pneumothorax after repair of esophageal atresia/tracheoesophageal fistula. BMC Pediatr 2021; 21:543. [PMID: 34861834 PMCID: PMC8641193 DOI: 10.1186/s12887-021-02948-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background To analyze the possible causes, treatment and outcomes of postoperative pneumothorax in patients with Gross type C esophageal atresia/tracheoesophageal fistula (EA/TEF). Methods Medical records of patients with Gross type C EA/TEF who were diagnosed and treated in Beijing Children’s Hospital from January 2007 to January 2020 were retrospectively collected. They were divided into 2 groups according to whether postoperative pneumothorax occurred. Univariate and multivariate logistic regression analysis were performed to identify risk factors for pneumothorax. Results A total of 188 patients were included, including 85 (45 %) in the pneumothorax group and 103 (55 %) in the non-pneumothorax group. Multivariate logistic regression analysis showed that postoperative anastomotic leakage [P < 0.001, OR 3.516 (1.859, 6.648)] and mechanical ventilation [P = 0.012, OR 2.399 (1.210, 4.758)] were independent risk factors for pneumothorax after EA/TEF repair. Further analysis of main parameters of mechanical ventilation after surgery showed that none of them were clearly related to the occurrence of pneumothorax. Among the 85 patients with pneumothorax, 33 gave up after surgery and 52 received further treatment [conservative observation (n = 20), pleural puncture (n = 11), pleural closed drainage (n = 9), both pleural puncture and closed drainage (n = 12)]. All of the 52 patients were cured of pneumothorax at discharge. Conclusions Anastomotic leakage and postoperative mechanical ventilation were risk factors for pneumothorax after repair of Gross type C EA/TEF, but the main parameters of mechanical ventilation had no clear correlation with pneumothorax. After symptomatic treatment, the prognosis of pneumothorax was good. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02948-x.
Collapse
Affiliation(s)
- Jiawei Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Shen Yang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Siqi Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Peize Wang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yanan Zhang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yong Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Kaiyun Hua
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yichao Gu
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Junmin Liao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Shuangshuang Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yongwei Chen
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China.
| |
Collapse
|
8
|
van Hoorn CE, de Graaff JC, Vlot J, Wijnen RM, Stolker RJ, Schnater JM. Primary repair of esophageal atresia is followed by multiple diagnostic and surgical procedures. J Pediatr Surg 2021; 56:2192-2199. [PMID: 34229878 DOI: 10.1016/j.jpedsurg.2021.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children born with esophageal atresia (EA) face comorbidities and complications often requiring surgery and anesthesia. We aimed to assess all procedures performed under general anesthesia during their first 12 years of life. METHODS We performed a retrospective cohort study about subsequent surgeries and procedures requiring general anesthesia in children born with type C EA between January 2007 and December 2017, with follow-up to March 2019. RESULTS Of 102 eligible patients, 63 were diagnosed with comorbidities, of whom 18 had VACTERL association. Follow-up time for all patients varied between 14 months and 12 years (median 7 years). The patients underwent total 637 procedures, median 4 [IQR2-7] per patient. In the first year of life, 464 procedures were performed, in the second year 69 and in the third year 29. Thirteen patients underwent no other procedures than primary EA repair. In 57 patients, 228 dilatations were performed. Other frequently performed procedures were esophagoscopy (n=52), urologic procedures (n=44) and abdominal procedures (n=33). CONCLUSIONS Patients with EA frequently require multiple anesthetics for a variety of procedures related to the EA, complications and comorbidities. This study can help care providers when counselling parents of a patient with an EA by giving them more insight into possible procedures they can be confronted with during childhood.
Collapse
Affiliation(s)
- Camille E van Hoorn
- Department of Anesthesiology, Erasmus University Medical Centre -Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatric Surgery and Pediatric Intensive Care, Erasmus University Medical Centre -Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Jurgen C de Graaff
- Department of Anesthesiology, Erasmus University Medical Centre -Sophia Children's Hospital, Rotterdam, The Netherlands
| | - John Vlot
- Department of Pediatric Surgery and Pediatric Intensive Care, Erasmus University Medical Centre -Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rene Mh Wijnen
- Department of Pediatric Surgery and Pediatric Intensive Care, Erasmus University Medical Centre -Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus University Medical Centre -Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J Marco Schnater
- Department of Pediatric Surgery and Pediatric Intensive Care, Erasmus University Medical Centre -Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
9
|
Association of operative approach with outcomes in neonates with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2021; 56:2172-2179. [PMID: 33994203 DOI: 10.1016/j.jpedsurg.2021.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE We sought to evaluate the impact of thoracoscopic repair on perioperative outcomes in infants with esophageal atresia and tracheoesophageal fistula (EA/TEF). METHODS The American College of Surgeons National Surgical Quality Improvement Program pediatric database from 2014 to 2018 was queried for all neonates who underwent operative repair of EA/TEF. Operative approach based on intention to treat was correlated with perioperative outcomes, including 30-day postoperative adverse events, in logistic regression models. RESULTS Among 855 neonates, initial thoracoscopic repair was performed in 133 (15.6%) cases. Seventy (53%) of these cases were converted to open. Those who underwent thoracoscopic repair were more likely to be full-term (p = 0.03) when compared to those in the open repair group. There were no significant differences in perioperative outcome measures based on surgical approach except for operative time (thoracoscopic: 217 min vs. open: 180 min, p<0.001). A major cardiac comorbidity (OR 1.6, 95% CI 1.2-2.1; p = 0.003) and preoperative ventilator requirement (OR 1.4, 95% CI 1.0-1.9; p = 0.034) were the only risk factors associated with adverse events. CONCLUSIONS Thoracoscopic neonatal repair of EA/TEF continues to be used sparingly, is associated with high conversion rates, and has similar perioperative outcomes when compared to open repair. LEVEL OF EVIDENCE III.
Collapse
|
10
|
Muensterer OJ, Evans LL, Sterlin A, Sahlabadi M, Aribindi V, Lindner A, König T, Harrison MR. Novel Device for Endoluminal Esophageal Atresia Repair: First-in-Human Experience. Pediatrics 2021; 148:peds.2020-049627. [PMID: 34615695 DOI: 10.1542/peds.2020-049627] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/22/2022] Open
Abstract
Thoracoscopic esophageal atresia (EA) repair affords many benefits to the patient; however, intracorporeal suturing of the anastomosis is technically challenging. Esophageal magnetic compression anastomosis (EMCA) is a compelling option for endoluminal EA repair, but available EMCA devices have prohibitive rates of recalcitrant stricture. Connect-EA is a new endoluminal EMCA device system that employs 2 magnetic anchors with a unique mating geometry designed to reliably create a robust anastomosis and decrease rates of leak and stricture. We describe our first-in-human experience with this novel endoluminal device for staged EA repair in 3 patients (Gross type A, B, and C) at high risk for conventional surgical repair. First, the esophageal pouches were approximated thoracoscopically. After acute tension subsided, the device anchors were endoscopically placed in the esophageal pouches and mated. Anchors were spontaneously excreted in 2 cases. Endoscopic repositioning and retrieval of the anchors were required in 1 patient because of narrowed esophageal anatomy. There were no perioperative complications. Patients were managed for 14 to 18 months. The strictures that developed in the patients were membranous and responded well to dilation alone, resolving after 4 to 5 outpatient dilations. Gastrostomies were closed between 6 and 11 months and all patients are tolerating full oral nutrition. Early experience with this new endoluminal EMCA device system is highly favorable. The device offers considerable benefit over conventional handsewn esophageal anastomosis and anastomotic outcomes are superior to available EMCA devices.
Collapse
Affiliation(s)
- Oliver J Muensterer
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany .,Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Lauren L Evans
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Alexander Sterlin
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mohammad Sahlabadi
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Vamsi Aribindi
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Andreas Lindner
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Tatjana König
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael R Harrison
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| |
Collapse
|
11
|
Kiblawi R, Zoeller C, Zanini A, Ure BM, Dingemann J, Kuebler JF, Schukfeh N. Video-Assisted Thoracoscopic or Conventional Thoracic Surgery in Infants and Children: Current Evidence. Eur J Pediatr Surg 2021; 31:54-64. [PMID: 33027837 DOI: 10.1055/s-0040-1716878] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The pros and cons of video-assisted thoracoscopic versus conventional thoracic surgery in infants and children are still under debate. We assessed reported advantages and disadvantages of video-assisted thoracoscopy in pediatric surgical procedures, as well as the evidence level of the available data. MATERIALS AND METHODS A systematic literature search was performed to identify manuscripts comparing video-assisted thoracoscopic and the respective conventional thoracic approach in classic operative indications of pediatric surgery. Outcome parameters were analyzed and graded for level of evidence (according to the Oxford Centre of Evidence-Based Medicine). RESULTS A total of 48 comparative studies reporting on 12,709 patients, 11 meta-analyses, and one pilot randomized controlled trial including 20 patients were identified. More than 15 different types of advantages for video-assisted thoracoscopic surgery were described, mostly with a level of evidence 3b or 3a. Most frequently video-assisted thoracoscopic surgery was associated with shorter hospital stay, shorter postoperative ventilation, and shorter time to chest drain removal. Mortality rate and severe complications did not differ between thoracoscopic and conventional thoracic pediatric surgery, except for congenital diaphragmatic hernia repair with a lower mortality and higher recurrence rate after thoracoscopic repair. The most frequently reported disadvantage for video-assisted thoracoscopic surgery was longer operative time. CONCLUSION The available data point toward improved recovery in pediatric video-assisted thoracoscopic surgery despite longer operative times. Further randomized controlled trials are needed to justify the widespread use of video assisted thoracoscopy in pediatric surgery.
Collapse
Affiliation(s)
- Rim Kiblawi
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Christoph Zoeller
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Andrea Zanini
- Department of Pediatric Surgery, University of Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Jens Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Nagoud Schukfeh
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| |
Collapse
|
12
|
Marinho AS, Saxena AK. Thoracoscopic Esophageal Atresia Repair: Outcomes Analysis Between Primary and Staged Procedures. Surg Laparosc Endosc Percutan Tech 2020; 31:363-367. [PMID: 33394975 DOI: 10.1097/sle.0000000000000895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Thoracoscopic repair of esophageal atresia (EA) is analyzed in this systematic review that compares outcomes between primary and staged repairs. MATERIALS AND METHODS PubMed/Embase databases were reviewed for articles on thoracoscopic repair of EA, and articles were selected for primary and staged repairs. Descriptive statistics were used to analyze the quantitative parts of the study. RESULTS Thirty-six articles identified between 1999 and 2019 met the inclusion criteria and offered 776 patients for this analysis. Primary repairs were performed in n=703 and staged repairs in n=73. Comparative analysis showed that esophageal anastomosis was performed using absorbable suture in 88% primary and 78% staged repairs. Anastomotic leak rates were comparable between primary n=65/696 (9%) and staged repairs n=8/73 (11%). The re-fistulation rate was 2% in primary and 1% in staged repairs. There was no difference between suture material and re-fistulation (P>0.05; NS). In primary repairs, nonabsorbable sutures were found to be associated with more leaks than absorbable sutures (P<0.05*). The conversion rate was similar between 2 approaches; primary n=49/680 (7%) and staged n=6/73 (8%); P>0.05. No significant differences were found in the rate of anastomosis strictures between primary n=135/703 (19%) and staged repair n=21/73 (29%); P>0.05. The overall mortality was n=20/703 (3%) in primary and n=1/73 (1%) in staged repairs; P>0.05. CONCLUSIONS Successful thoracoscopic primary- and staged-EA repairs have been reported with low rate of complications. Outcomes between primary and staged repairs do not show significant differences with regards to re-fistulation, anastomotic leaks, conversion rates, and mortality.
Collapse
Affiliation(s)
- Ana S Marinho
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster NHS Foundation Trust, Imperial College London, London, UK
| | | |
Collapse
|
13
|
Elhattab A, Ali L, Rousseau V, Clermidi P, Michelet D, Farnoux C, Lapillonne A, Aly KAE, Sarnacki S, Bonnard A, Khen-Dunlop N. Thoracoscopy Versus Thoracotomy in the Repair of Esophageal Atresia with Distal Tracheoesophageal Fistula. J Laparoendosc Adv Surg Tech A 2020; 30:1289-1294. [DOI: 10.1089/lap.2020.0642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ahmad Elhattab
- Department of Pediatric Surgery, AP-HP, Hopital Necker-Enfants Malades, Paris, France
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Liza Ali
- Department of Pediatric Surgery and AP-HP, Hopital Robert Debre, Paris, France
| | - Veronique Rousseau
- Department of Pediatric Surgery, AP-HP, Hopital Necker-Enfants Malades, Paris, France
| | - Pauline Clermidi
- Department of Pediatric Surgery, AP-HP, Hopital Necker-Enfants Malades, Paris, France
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Daphné Michelet
- Department of Anesthesia, AP-HP, Hopital Robert Debre, Paris, France
| | - Caroline Farnoux
- Department of Pediatric Surgery and AP-HP, Hopital Robert Debre, Paris, France
| | - Alexandre Lapillonne
- Neonatal Care Unit, AP-HP, Hopital Necker-Enfants Malades, Paris, France
- Université de Paris, Paris, France
| | - Kamal Abdel-Elah Aly
- Department of Pediatric Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Sabine Sarnacki
- Department of Pediatric Surgery, AP-HP, Hopital Necker-Enfants Malades, Paris, France
- Université de Paris, Paris, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery and AP-HP, Hopital Robert Debre, Paris, France
- Université de Paris, Paris, France
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery, AP-HP, Hopital Necker-Enfants Malades, Paris, France
- Université de Paris, Paris, France
| |
Collapse
|
14
|
|
15
|
Rozeik AE, Elbarbary MM, Saleh AM, Khodary AR, Al-Ekrashy MA. Thoracoscopic versus conventional open repair of tracheoesophageal fistula in neonates: A short-term comparative study. J Pediatr Surg 2020; 55:1854-1859. [PMID: 31785836 DOI: 10.1016/j.jpedsurg.2019.09.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/26/2019] [Accepted: 09/23/2019] [Indexed: 11/15/2022]
Abstract
PURPOSE Esophageal atresia with or without a tracheo-esophageal fistula is a challenging anomaly in neonates. Thoracoscopic repair is gaining popularity now in pediatric surgery community. The present study aims at comparing the short term outcomes of thoracoscopy versus classic thoracotomy for repair of such conditions. METHODS Thirty neonates with tracheoesophageal fistula were randomly divided into two equal groups (n=15) after excluding patients with birth weight <2000g, multiple associated anomalies and cardiorespiratory instability. One group had conventional open repair while the other had thoracoscopic repair. Demographic data, intraoperative result and post-operative findings were recorded and compared between both groups. RESULTS Both groups showed similar results regarding demographic and patients' characteristics. Thoracoscopic repair had relatively longer, yet non-significant operative time but with highly significant difference in preserving azygos vein. There was low conversion rate with thoracoscopy (6.66%). Open repair resulted in a longer hospital stay (11.73±5.68 vs 9.2±2.95). Complication rate was comparable in both groups; however, thoracoscopy was associated with better cosmetic results as reported by parents and surgeons (p=0.00). CONCLUSION Compared to thoracotomy, thoracoscopic repair offers a less invasive, effective and safe technique with similar short term outcomes, but with superior cosmetic results and better ability to spare azygos vein. TYPE OF STUDY Therapeutic/Treatment study LEVEL OF EVIDENCE: Level II.
Collapse
Affiliation(s)
- Ahmed Ezzat Rozeik
- Pediatric Surgery Department, Zagazig University Hospitals, Zagazig, Egypt
| | - Mohamed Magdy Elbarbary
- Pediatric Surgery Department, Cairo University Children Hospital (Abu El-Reesh), Cairo, Egypt
| | - Amin Mohamed Saleh
- Pediatric Surgery Department, Zagazig University Hospitals, Zagazig, Egypt
| | | | | |
Collapse
|
16
|
Sidler M, Wong ZH, Eaton S, Ahmad N, Ong M, Morsi A, Rees CM, Giuliani S, Blackburn S, Curry JI, Cross KM, De Coppi P. Insufflation in minimally invasive surgery: Is there any advantage in staying low? J Pediatr Surg 2020; 55:1356-1362. [PMID: 32102738 DOI: 10.1016/j.jpedsurg.2019.11.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
AIM Minimally invasive repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) and congenital diaphragmatic hernia (CDH) is feasible and confers benefits compared to thoracotomy or laparotomy. However, carbon dioxide (CO2) insufflation can lead to hypercapnia and acidosis. We sought to determine the effect of lower insufflation pressures on patients' surrogate markers for CO2 absorption - arterial partial pressure of CO2 (PaCO2), end tidal CO2 (EtCO2) and pH. METHODS Single center retrospective review, including neonates without major cardiac anomaly. Selected patients formed 2 groups: Historical pressure (HP) group and low pressure (LP) group. We reported on the patients' preoperative characteristics that potentially confound the degree of CO2 absorption or elimination. Outcome measures were perioperative PaCO2, EtCO2, arterial pH and anesthetic time. RESULTS 30 patients underwent minimally invasive surgery for CDH and 24 patients for EA/TEF with similar distribution within the HP and LP group. For CDH patients as well as for EA/TEF patients, there were no significant differences in their preoperative characteristics or surgery duration comparing HP and LP groups. With a decrease in insufflation pressure in CDH patients, there were a significant decrease (p = 0.002) in peak PaCO2 and an improvement in nadir pH (p = 0.01). For the EA/TEF patients, the decrease in insufflation pressure was associated with a significant decrease (p = 0.03) in peak EtCO2. Considering all 54 patients, we found EtCO2 to be highly significantly inversely correlated with pH and positively correlated with intraoperative PaCO2 (p < 0.001). Baseline Hb was inversely correlated with mean EtCO2 (p < 0.001). CONCLUSION With lower insufflation pressures, CDH patients had significantly improved hypercapnia and acidosis, while EA/TEF patients had significantly reduced EtCO2. EtCO2 was correlated with acidosis and hypercapnia. TYPE OF STUDY Retrospective case control study. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Martin Sidler
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom; Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom
| | - Zeng Hao Wong
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Simon Eaton
- Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom
| | - Nargis Ahmad
- Paediatric Anaesthesia, Great Ormond Street Hospital, London, United Kingdom
| | - Meydene Ong
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Ahmed Morsi
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Clare M Rees
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Stefano Giuliani
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Simon Blackburn
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Joseph I Curry
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Kate M Cross
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom; Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom.
| |
Collapse
|
17
|
Zhang J, Wu Q, Chen L, Wang Y, Cui X, Huang W, Zhou C. Clinical analysis of surgery for type III esophageal atresia via thoracoscopy: a study of a Chinese single-center experience. J Cardiothorac Surg 2020; 15:55. [PMID: 32228652 PMCID: PMC7106587 DOI: 10.1186/s13019-020-01097-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the effectiveness and safety of the operation for type III esophageal atresia using a thoracoscope. METHODS The clinical data for 92 patients with type III esophageal atresia in our hospital from January 2015 to December 2018 were analyzed retrospectively. There were 49 patients in group A who underwent thoracoscopic surgery and 43 patients in group B who underwent conventional surgery. RESULTS The mechanical ventilation time (55.7 ± 11.4 h vs 75.6 ± 19.2 h), intensive care time (3.6 ± 1.8d vs 4.7 ± 2.0d), postoperative hospitalization time (13.1 ± 2.2d vs 16.8 ± 4.3d), thoracic drainage volume (62.7 ± 25.5 ml vs 125.4 ± 46.1 ml), blood transfusion volume (30.5 ± 10.4 ml vs 55.3 ± 22.7 ml) and surgical incision length (2.0 ± 0.5 cm vs 8.0 ± 1.8 cm) in group A were lower than those in group B, and the differences were statistically significant (P < 0.05). Among the postoperative complications, the incidences of postoperative severe pneumonia (8.2% vs 23.3%), poor wound healing (2.0% vs 14.0%) and chest wall deformity (0% vs 11.6%) in group A were significantly lower than those in group B (P < 0.05). There was no significant difference in the incidence of anastomotic stricture, tracheomalacia or gastroesophageal reflux between the two groups after surgery and early during follow-up (P > 0.05), and there were no complications such as achalasia signs and esophageal diverticulum in either group. CONCLUSION Surgery for type III esophageal atresia via thoracoscopy has the same safety and clinical effectiveness as traditional surgery and has the advantages of smaller incision and chest wall deformity.
Collapse
Affiliation(s)
- Jianqin Zhang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, P. R. China
| | - Qiang Wu
- Department of Pediatric Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, P. R. China
| | - Liu Chen
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, P. R. China
| | - Yunjin Wang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, P. R. China
| | - Xu Cui
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, P. R. China
| | - Wenhua Huang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, P. R. China
| | - Chaoming Zhou
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, P. R. China.
| |
Collapse
|
18
|
Thoracoscopy vs. thoracotomy for the repair of esophageal atresia and tracheoesophageal fistula: a systematic review and meta-analysis. Pediatr Surg Int 2019; 35:1167-1184. [PMID: 31359222 DOI: 10.1007/s00383-019-04527-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2019] [Indexed: 12/14/2022]
Abstract
Esophageal atresia (EA) and tracheoesophageal fistula (TEF) require emergency surgery in the neonatal period to prevent aspiration and respiratory compromise. Surgery was once exclusively performed via thoracotomy; however, there has been a push to correct this anomaly thoracoscopically. In this study, we compare intra- and post-operative outcomes of both techniques. A systematic review and meta-analyses was performed. A search strategy was developed in consultation with a librarian which was executed in CENTRAL, MEDLINE, and EMBASE from inception until January 2017. Two independent researchers screened eligible articles at title and abstract level. Full texts of potentially relevant articles were then screened again. Relevant data were extracted and analyzed. 48 articles were included. A meta-analysis found no statistically significant difference between thoracoscopy and thoracotomy in our primary outcome of total complication rate (OR 0.98, [0.29, 3.24], p = 0.97). Likewise, there were no statistically significant differences in anastomotic leak rates (OR 1.55, [0.72, 3.34], p = 0.26), formation of esophageal strictures following anastomoses that required one or more dilations (OR 1.92, [0.93, 3.98], p = 0.08), need for fundoplication following EA repair (OR 1.22, [0.39, 3.75], p = 0.73)-with the exception of operative time (MD 30.68, [4.35, 57.01], p = 0.02). Considering results from thoracoscopy alone, overall mortality in patients was low at 3.2% and in most cases was due to an associated anomaly rather than EA repair. Repair of EA/TEF is safe, with no statistically significant differences in morbidity when compared with an open approach.Level of evidence 3a systematic review of case-control studies.
Collapse
|
19
|
Abstract
Thoracoscopic repair (TR) of esophageal atresia (EA) has been performed with increasing frequency over the last two decades, with the expectation of improved outcomes by avoiding thoracotomy. To understand the current practice and outcomes of TR of EA, we reviewed the relevant literature, including 15 case series, 7 comparative studies, and 3 meta-analysis comparing TR with conventional open repair (COR). Most of the studies had a retrospective design and small numbers of patients. Although the evidence level is low because of the lack of prospective studies, this review found that TR is as safe as COR, with comparative outcomes. Moreover, there were several advantages of TR over COR, such as less blood loss and a shorter hospital stay. The long-term outcomes of TR remain unclear because of limited data. Moreover, there is a significant learning curve over the first 10-20 TRs performed. We conclude that TR of EA, when conducted by experienced surgeons, is a safe and minimally invasive alternative to COR and may yield better results than COR in appropriately selected patients.
Collapse
|
20
|
van Hoorn CE, Costerus SA, Lau J, Wijnen RMH, Vlot J, Tibboel D, de Graaff JC. Perioperative management of esophageal atresia/tracheo-esophageal fistula: An analysis of data of 101 consecutive patients. Paediatr Anaesth 2019; 29:1024-1032. [PMID: 31343794 DOI: 10.1111/pan.13711] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/16/2019] [Accepted: 07/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The perioperative management of esophageal atresia/tracheo-esophageal fistula by open or thoracoscopic approach can be complicated by metabolic derangements. Little is known, however, about the severity of derangements of vital and metabolic parameters in the perioperative period. AIM The aim of this study is to describe the perioperative courses of vital and metabolic parameters in 101 consecutive neonates undergoing surgical repair of esophageal atresia type C. METHOD In a retrospective cohort study, we extracted all data from the electronic anesthetic and medical charts of patients who underwent esophageal atresia type C repair within 30 days of life (2007-2017). We distinguished three types of surgery: primary open, primary thoracoscopic, and primary thoracoscopic surgery converted to open surgery. Descriptive analysis was applied. RESULTS The charts of 117 patients were reviewed: data of 101 were included. The perioperative anesthetic management was not standardized; various methods and medications were used for anesthesia induction and maintenance. Intraoperative blood gas analysis data of 72 patients were available and showed derangements regardless of type of surgery. The median pH-value decreased to 7.21 [IQR 7.14-7.30] and a pH-value below 7.20 was found in 29 patients; in four cases below 7.0, with the lowest value 6.83. The median PaCO2 reached an upper level of 7.5kPa [IQR 5.8-9.2]; in 13 cases above 10.0kPa, with a peak value of 25.8kPa. These high PaCO2 levels fluctuated with lowest measured PaCO2 of median 5.6 [IQR 4.5-6.6], with the lowest value 2.8kPa. The median PaO2 level reached an upper level of 16.9kPa [IQR 11.8-25.7], in 22 cases above 20.0kPa, with a peak value of 50.0kPa. These high levels fluctuated with lowest measured PaO2 levels of median 8.3kPa [IQR 6.73-10.5]; the lowest PaO2 value was 4.7 kPa. CONCLUSION Open and thoracoscopic correction of esophageal atresia were associated with periods of severe metabolic derangements. These events need to be taken into account for the evaluation of esophageal atresia (surgical) care and in evaluations of short- and long-term outcomes.
Collapse
Affiliation(s)
- Camille E van Hoorn
- Department of Anesthesiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sophie A Costerus
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jessica Lau
- Department of Anesthesiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rene M H Wijnen
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - John Vlot
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jurgen C de Graaff
- Department of Anesthesiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
21
|
Lin CH, Duh YC, Fu YW, Hsu YJ, Wei CH. Thoracoscopic repair of esophageal atresia. FORMOSAN JOURNAL OF SURGERY 2018; 51:105-110. [DOI: 10.4103/fjs.fjs_145_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
22
|
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; 33:1147-1157. [PMID: 28914345 DOI: 10.1007/s00383-017-4153-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE A meta-analysis was performed for a comparison of outcomes between open repair (OR) and thoracoscopic repair (TR) for esophageal atresia with tracheoesophageal fistula (EA with TEF). METHODS Electronic databases, including PubMed, Cochrane Library, and Medline, were searched systematically for the literatures aimed mainly at comparing the therapeutic effects for EA with TEF administrated by OR and TR. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. Meta-analysis was performed with Stata 12.0. RESULTS Ten studies meeting the inclusion criteria were included, involving 447 subjects in total. It was observed that OR entailed a shorter operative time with significant statistical differences (SMD 0.604; 95% CI 0.344-0.864, P = 0). While TR was superior in two aspects: shorter length of hospital stay (SMD 0.584; 95% CI 0.214-0.953; P = 0.002) and shorter first oral feeding time (SMD 0.652; 95% CI 0.27-1.035; P = 0.001). However, meta-analyses of occurrence rate of leaks (OR, 1.747; 95% CI 0.817-3.737; P = 0.15), strictures (OR, 0.937; 95% CI 0.5-1.757; P = 0.839), pulmonary complications (OR, 1.08; 95% CI 0.21-5.44; P = 0.897), fundoplication rate of Gastroesophageal Reflux Disease (GERD) (OR, 1.642; 95% CI 0.855-3.153; P = 0.601), and blood loss (SMD 0.048; 95% CI -1.292 to 1.388; P = 0.944) showed no significant differences between OR and TR. Meta-analysis of ventilation time showed similar outcome between OR and TR (SMD 0.474; 95% CI 0.02-0.968; P = 0.06), but the result remained controversial due to estimated result changing after sensitivity analysis (SMD 0.61; 95% CI 0.16-1.07; P = 0). CONCLUSIONS Compared with OR, a longer operative time was associated within TR group, although the TR procedure could possibly reduce the length of hospital stay and first oral feeding time. Meanwhile, the occurrence rate for leaks, strictures, pulmonary complications, and the fundoplication rate of GERD, and blood loss were similar between the OR and TR groups. Estimated result of ventilation time between the two groups remained ambiguous.
Collapse
Affiliation(s)
- Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Hongyu Kuang
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Tiewei Lv
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
| |
Collapse
|
23
|
Miyano G, Seo S, Nakamura H, Sueyoshi R, Okawada M, Doi T, Koga H, Lane GJ, Yamataka A. Changes in quality of life from infancy to school age after esophagoesophagostomy for tracheoesophageal fistula: thoracotomy versus thoracoscopy. Pediatr Surg Int 2017; 33:1087-1090. [PMID: 28831606 DOI: 10.1007/s00383-017-4141-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND We assessed the quality of life (QOL) of postoperative esophageal atresia (EA) with tracheoesophageal fistula (TEF) cases, comparing open with thoracoscopic repair. METHODS A retrospective review of consecutive EA/TEF repairs (2001-2014) was performed, excluding cases with birth weight less than 2000 g and severe cardiac/chromosomal anomalies. Of 37 cases, 13 had thoracoscopic repair (TR) and 24 had open repair (OR) according to the operating surgeon's preference. QOL was determined regularly by scoring responses to a standard questionnaire about oral intake, vomiting, bougienage, coughing, growth retardation, learning ability, and thoracic deformity. Lower scores reflected poorer outcome. QOL after TR and OR was compared 1 year postoperatively (POQ) and after starting school (ScQ). RESULTS Subject demographics were similar. Apart from two anastomotic leaks that resolved spontaneously after TR, there were no intraoperative complications or recurrence of TEF. Laparoscopic fundoplication was required for gastroesophageal reflux in four cases (OR 1; TR 3) (p = ns). QOL scores went from 6.5 → 11.5 in OR and 4.6 → 11.3 in TR, respectively. Final ScQ scores were similar, but POQ was significantly higher after OR (p < 0.05). CONCLUSION Initial QOL scores were significantly lower after TR, but by school age QOL scores were similar.
Collapse
Affiliation(s)
- Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Shogo Seo
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroki Nakamura
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryo Sueyoshi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Manabu Okawada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Doi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
24
|
Kanojia RP, Bhardwaj N, Dwivedi D, Kumar R, Joshi S, Samujh R, Rao KLN. Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: Basics of technique and its nuances. J Indian Assoc Pediatr Surg 2016; 21:120-4. [PMID: 27365905 PMCID: PMC4895736 DOI: 10.4103/0971-9261.182585] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: To review the technique of thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (TREAT) and results reported in literature and with authors’ experience. Patients and Methods: The technique of TREAT was reviewed in detail with evaluation in patients treated at authors’ institution. The patients were selected based on selection criteria and were followed postoperatively. The results available in literature were also reviewed. Results: A total of 29 patients (8 females) were operated by TREAT. Mean age was 2.8 days (range 2-6 days). Mean weight was 2.6 kg (range 1.8-3.2 kg). There was a leak in four patients, and two patients had to be diverted. They are now awaiting definitive repair. Twenty-one patients have completed a mean follow-up of 1.5 years and are doing well except for two patients who had a stricture and underwent serial esophageal dilatations. The results from current literature are provided in tabulated form. Conclusions: TREAT is now a well-established procedure and currently is the preferred approach wherever feasible. The avoidance of thoracotomy is a major advantage to the newborn and is proven to benefit the recovery in the postoperative patient. The technique demonstrated, and the tweaks reported make the procedure easy and is helpful to beginners. The outcome is very much comparable to the open repair as proven by various series. Various parameters like leak rate, anastomotic stricture are the same. The outcome is comparable if you TREAT these babies well.
Collapse
Affiliation(s)
- Ravi Prakash Kanojia
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Dwivedi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raj Kumar
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saajan Joshi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K L N Rao
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
25
|
Yang YF, Dong R, Zheng C, Jin Z, Chen G, Huang YL, Zheng S. Outcomes of thoracoscopy versus thoracotomy for esophageal atresia with tracheoesophageal fistula repair: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e4428. [PMID: 27472740 PMCID: PMC5265877 DOI: 10.1097/md.0000000000004428] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A thoracoscopic approach for repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) has become a standard procedure in many pediatric surgical centers. However, whether thoracotomy or thoracoscopy offer advantages in terms of surgical outcomes is not known. METHODS To evaluate the efficacy and safety of thoracoscopic repair (TR) versus conventional open repair (COR) for EA with TEF.PubMed, Cochrane Library, and EMBASE were searched to identify relevant literature until 2016.Studies comparing surgical outcomes of patients undergoing TR versus COR for EA with TEF were reviewed.The quality of each included study was assessed using the Newcastle-Ottawa scale score. A fixed or random-effect model was applied depending on heterogeneity tests. RESULTS Eight observational clinical studies involving 452 patients were included in this meta-analysis. The meta-analysis of 2 major postoperative complications (leaks and strictures) did not show significant differences between TR and COR. Overall estimates of the odds ratio (OR) of TR versus COR for leaks and strictures were: 1.57 (95% confidence interval [CI], 0.77-3.20; P = 0.22) and 0.90 (95% CI, 0.27-2.97; P = 0.86), respectively. However, meta-analysis of operation time (OR = 19.59, 95% CI = 0.77-38.40, P = 0.04), timing of extubation (OR = -2.50, 95% CI = -3.39 to -1.62, P < 0.001), time to 1st oral feeding (OR = -2.58, 95% CI = -3.79 to -1.36, P < 0.001), and duration of hospital stay (OR = -10.76, 95% CI = -16.39 to -5.12, P < 0.001) showed significant differences.No randomized controlled trial was included, and most studies had small sample sizes and were based on retrospective analysis. CONCLUSION TR and COR show a similar complication rates of leaks and strictures for EA/TEF repair. Although associated with a longer operative time, TR has the advantages of an earlier time to extubation and 1st oral feeding, and shorter hospital stay.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
- Correspondence: Shan Zheng, Department of Pediatric Surgery, Children's Hospital of Fudan University, and Key Laboratory of Neonatal Disease, Ministry of Health, 399 Wan Yuan Road, Shanghai 201102, China (e-mail: )
| |
Collapse
|
26
|
Neonatal brain oxygenation during thoracoscopic correction of esophageal atresia. Surg Endosc 2015; 30:2811-7. [PMID: 26490769 PMCID: PMC4912583 DOI: 10.1007/s00464-015-4559-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022]
Abstract
Background Little is known about the effects of carbon dioxide (CO2) insufflation on cerebral oxygenation during thoracoscopy in neonates. Near-infrared spectroscopy can measure perioperative brain oxygenation [regional cerebral oxygen saturation (rScO2)]. Aims To evaluate the effects of CO2 insufflation on rScO2 during thoracoscopic esophageal atresia (EA) repair. Methods This is an observational study during thoracoscopic EA repair with 5 mmHg CO2 insufflation pressure. Mean arterial blood pressure (MABP), arterial oxygen saturation (SaO2), partial pressure of arterial carbon dioxide (paCO2), pH, and rScO2 were monitored in 15 neonates at seven time points: baseline (T0), after anesthesia induction (T1), after CO2-insufflation (T2), before CO2-exsufflation (T3), and postoperatively at 6 (T4), 12 (T5), and 24 h (T6). Results MABP remained stable. SaO2 decreased from T0 to T2 [97 ± 3–90 ± 6 % (p < 0.01)]. PaCO2 increased from T0 to T2 [41 ± 6–54 ± 15 mmHg (p < 0.01)]. pH decreased from T0 to T2 [7.33 ± 0.04–7.25 ± 0.11 (p < 0.05)]. All parameters recovered during the surgical course. Mean rScO2 was significantly higher at T1 compared to T2 [77 ± 10–73 ± 7 % (p < 0.05)]. Mean rScO2 levels never dropped below a safety threshold of 55 %. Conclusion The impact of neonatal thoracoscopic repair of EA with insufflation of CO2 at 5 mmHg was studied. Intrathoracic CO2 insufflation caused a reversible decrease in SaO2 and pH and an increase in paCO2. The rScO2 was higher at anesthesia induction but remained stable and within normal limits during and after the CO2 pneumothorax, which suggest no hampering of cerebral oxygenation by the thoracoscopic intervention. Future studies will focus on the long-term effects of this surgery on the developing brain.
Collapse
|