Thoracotomy versus thoracoscopy in repair of esophageal atresia, prospective comparative study

Abstract

Abstract Background Pediatric esophageal atresia management has come a long way in recent years. Early diagnosis and better neonatal ICU and anesthesia have contributed to a steady decline in infant mortality. Aim of the study The present study aims to compare the outcome of thoracoscopic versus classic conventional open repair of tracheoesophageal fistula with esophageal atresia in neonates. Patients and methods The study was conducted at the Pediatric Surgery Department in Sohag University Hospitals and Cairo University during the duration from July 2022 to July 2024. The patients were divided into 2 groups: Group I (35 Patients): Conventional Open Repair group (COR) and Group II (20 Patients): Thoracoscopic Repair group (TR). The open thoracotomy group represented the conventional open practice in our institutions and included both intrapleural and extrapleural access. Results The thoracoscopic group required 105 min for the operation, while the open surgery group only needed 97 min. The two procedures were comparable regarding need of post-operative ventilation, early and late post-operative complications, 30-days morbidity and mortality in addition to re-intervention occurrence. Compared to the Open group, the thoracoscopic group maintained higher survival rates throughout the duration of the follow-up. At 180 days, 85% of patients in the thoracoscopic group survived, while 83% of those in the open group did not. Conclusions Thoracoscopic repair of type-C esophageal atresia with distal tracheoesophageal fistula was feasible in selected cardiorespiratorily stable neonates and provided expected access-related advantages. However, operative time was not shorter, and major postoperative outcomes were comparable to conventional open repair.