The following is a summary of “Short- and Long-Term Outcomes of Thoracoscopic and Open RepairFor Esophageal Atresia and Tracheoesophageal Fistula,” published in the August 2024 issue of Pediatrics by Yalcin et al.

This study aimed to evaluate both short- and long-term outcomes of thoracoscopic repair compared to open repair for esophageal atresia with tracheoesophageal fistula (EA/TEF) over 20 years, from 2000 to 2020. A retrospective analysis was conducted on 104 patients who underwent primary repair, excluding those with delayed repairs. Of these, 49 patients (47.1%) received thoracoscopic repair, chosen based on the surgeon’s discretion. The vast majority of cases (97.1%) were classified as Type C. Notably, patients in the thoracoscopic group exhibited higher gestational age and birth weight compared to those in the open repair group (p=0.001). The incidence of three or more VACTERL anomalies was more frequent in the open repair group (p=0.016). 

Operative time, anastomotic leak rates, and time to first oral feeding showed no significant differences between the two groups (p>0.05). However, the thoracoscopic group demonstrated a significantly reduced length of ventilation (p=0.026) and hospital stay (p=0.029). Despite these advantages, the anastomotic stricture rate was notably higher in the thoracoscopic group (p=0.012). Both groups had one case of recurrent TEF, and the rates of tube feeding at discharge and during the first year were similar (p>0.05), though the need for tube feeding at three years was lower in the thoracoscopic group (p=0.032). Additionally, there were no significant differences in the rates of anti-reflux medication use in the first and third years or the rate of fundoplication between the groups (p>0.05). 

While these findings suggest that thoracoscopic repair offers several advantages, such as shorter ventilation times and hospital stays, the increased risk of anastomotic stricture warrants careful consideration. Although selection bias could influence these results, they provide encouraging evidence for the continued development and safe implementation of thoracoscopic techniques in the repair of EA/TEF.

Source: sciencedirect.com/science/article/abs/pii/S0022346824004810