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

Autor: Cadaval C; Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain., Molino JA; Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain., Guillén G; Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain., López Fernández S; Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain., Hierro CL; Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain., Martos Rodríguez M; Neonatal Surgery Unit, Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain., Khan HA; Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain., Vilardell E; Division of Pediatric Anestethesiology, Universitat Autónoma de Barcelona, Barcelona, Spain., Andreu E; Division of Pediatric Anestethesiology, Universitat Autónoma de Barcelona, Barcelona, Spain., Ruiz CW; Division of Neonatology, Universitat Autónoma de Barcelona, Barcelona, Spain., López M; Department of Pediatric Surgery and Urology, Universitat Autónoma de Barcelona, Barcelona, Spain.
Jazyk: angličtina
Zdroj: European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie [Eur J Pediatr Surg] 2024 Aug; Vol. 34 (4), pp. 301-305. Date of Electronic Publication: 2023 Apr 13.
DOI: 10.1055/a-2072-9754
Abstrakt: 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 (pO 2 , pCO 2 , 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.
Competing Interests: None declared.
(Thieme. All rights reserved.)
Databáze: MEDLINE
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