Abstract
Introduction
Tracheoesophageal fistula with or without esophageal atresia (TEF–EA), a common thoracic congenital malformation, is traditionally corrected via open approach; however, minimally invasive thoracoscopic repair is fast gaining traction. There is paucity of evidence regarding superior or comparative surgical outcomes among the two techniques, emphasizing the need for a prospective, randomized trial.
Methodology
Sixteen neonates with TEF–EA were randomized equally into two intervention groups (Conventional Open Repair and Thoracoscopic Repair) after excluding patients with birth weight < 2 kg, associated anomalies, severe cardiorespiratory compromise, and prior attempted surgical repair. Both the groups were compared with respect to baseline characteristics, and various intraoperative and postoperative outcomes.
Results
Both the groups were comparable with regards to age at surgery, intraoperative blood loss and injuries, median duration of sedo-analgesia, inotropic support, and mechanical ventilation. The primary outcome, i.e., the combined incidence of anastomotic leak and stricture during 6-month follow-up period postoperatively, was not significantly different between the groups (p = 0.315). The median operating time and intraoperative end-tidal carbon dioxide was significantly higher in the thoracoscopic group (p < 0.001). Full oral feeds could be established significantly earlier in the thoracoscopic group (p = 0.048), and they also had a significantly shorter duration of hospital stay (p = 0.029).
Conclusion
Thoracoscopic repair (TR) of TEF is a safe, effective, minimal invasive surgical technique. The outcomes in terms of postoperative leak and early stricture rates were comparable between the groups. In addition to the already well-established advantages of minimal access approach, early discharge and early feeding are added benefits. As medical education continues to evolve, integrating inanimate models into the curriculum can empower surgeons to navigate the steep learning curve, ensuring the delivery of safe and effective patient care in the era of minimally invasive surgery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Spitz L (2007) Oesophageal atresia. Orphanet J Rare Dis 2:24
Keckler SJ, St Peter SD, Valusek PA, Tsao K, Snyder CL, Holcomb GW et al (2007) VACTERL anomalies in patients with esophageal atresia: an updated delineation of the spectrum and review of the literature. Pediatr Surg Int 23:309–313
Holcomb GW, Rothenberg SS, Bax KMA, Martinez-Ferro M, Albanese CT, Ostlie DJ et al (2005) Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis. Ann Surg 242:422–428
Rothenberg SS (2005) Thoracoscopic repair of esophageal atresia andtracheo-esophageal fistula. Semin Pediatr Surg 14:2–7
Lin CH, Duh YC, Fu YW, Hsu YJ, Wei CH (2018) Thoracoscopic repair of esophageal atresia: comparison with open approach. Formos J Surg 51:105
Al Tokhais T, Zamakhshary M, Aldekhayel S, Mandora H, Sayed S, AlHarbi K et al (2008) Thoracoscopic repair of tracheoesophageal fistulas: a case-control matched study. J Pediatr Surg 43:805–809
Lugo B, Malhotra A, Guner Y, Nguyen T, Ford H, Nguyen NX (2008) Thoracoscopic versus open repair of tracheoesophageal fistula and Esophageal atresia. J Laparoendosc Adv Surg Tech 18:753–756
Okuyama H, Koga H, Ishimaru T, Kawashima H, Yamataka A, Urushihara N et al (2015) Current practice and outcomes of thoracoscopic Esophageal atresia and tracheoesophageal fistula repair: a multi-institutional analysis in Japan. J Laparoendosc Adv Surg Tech A 25:441–444
Shaw-Smith C (2010) Genetic factors in esophageal atresia, tracheo-esophageal fistula and the VACTERL association: roles for FOXF1 and the 16q24.1 FOX transcription factor gene cluster, and review of the literature. Eur J Med Genet 53:6–13
Pinheiro PFM, Simões e Silva AC, Pereira RM (2012) Current knowledge on esophageal atresia. World J Gastroenterol 18:3662–3672
Borruto FA, Impellizzeri P, Montalto AS, Antonuccio P, Santacaterina E, Scalfari G et al (2012) Thoracoscopy versus thoracotomy for esophageal atresia and tracheoesophageal fistula repair: review of the literature and meta-analysis. Eur J Pediatr Surg 22:415–419
Yang YF, Dong R, Zheng C, Jin Z, Chen G, Huang YL et al (2016) Outcomes of thoracoscopy versus thoracotomy for esophageal atresia with tracheoesophageal fistula repair: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 95:e4428
Wu Y, Kuang H, Lv T, Wu C (2017) Comparison of clinical outcomes between open and thoracoscopic repair for esophageal atresia with tracheoesophageal fistula: a systematic review and meta-analysis. Pediatr Surg Int 33:1147–1157
Szavay PO, Zundel S, Blumenstock G, Kirschner HJ, Luithle T, Girisch M et al (2011) Perioperative outcome of patients with esophageal atresia and tracheo-esophageal fistula undergoing open versus thoracoscopic surgery. J Laparoendosc Adv Surg Tech A 21:439–443
Bishay M, Giacomello L, Retrosi G, Thyoka M, Garriboli M, Brierley J et al (2013) Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia: results of a pilot randomized controlled trial. Ann Surg 258:895–900
Koga H, Yamoto M, Okazaki T, Okawada M, Doi T, Miyano G et al (2014) Factors affecting postoperative respiratory tract function in type-C esophageal atresia. Thoracoscopic versus open repair. Pediatr Surg Int 30:1273–1277
Yamoto M, Urusihara N, Fukumoto K, Miyano G, Nouso H, Morita K et al (2014) Thoracoscopic versus open repair of esophageal atresia with tracheoesophageal fistula at a single institution. Pediatr Surg Int 30:883–887
Rozeik AE, Elbarbary MM, Saleh AM, Khodary AR, Al-Ekrashy MA (2020) Thoracoscopic versus conventional open repair of tracheoesophageal fistula in neonates: a short-term comparative study. J Pediatr Surg 55:1854–1859
Burford JM, Dassinger MS, Copeland DR, Keller JE, Smith SD (2011) Repair of esophageal atresia with tracheoesophageal fistula via thoracotomy: a contemporary series. Am J Surg 202:203–206
Konkin DE, O’hali WA, Webber EM, Blair GK (2003) Outcomes in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 38:1726–1729
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. Reddy, Dr. Peters, Dr. Malik, Prof Samujh, and Prof Mathew have no conflicts of interest.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Reddy, M., Peters, N.J., Malik, M.A. et al. Thoracoscopic repair (TR) versus conventional open repair (COR) for esophageal atresia–tracheoesophageal fistula (TEF–EA): a pilot randomized controlled trial. J Ped Endosc Surg 6, 45–53 (2024). https://doi.org/10.1007/s42804-023-00209-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s42804-023-00209-5