Thoracoscopic versus open repair of tracheoesophageal fistula and esophageal atresia

Objective To evaluate the efficacy and safety of thoracoscopic versus open techniques for esophageal atresia (EA) and tracheoesophageal fistula (TEF). Methods A retrospective review was performed for 50 type-Ⅲ EA/TEF patients.Twenty-five patients underwent thoracoscope from December 2012 to January 2014 at Jiangxi Children's Hospital while another 25 patients had traditional repair through thoracotomy from June 2008 to April 2014 at Capital Institute of Pediatrics.Definite diagnosis and complete operation were accomplished for 27 males and 23 females.The group of thoracoscope underwent a ligation of tracheoesophageal fistula and end-to-end esophageal anastomosis via 3 trocars while another group was operated through an extra-pleural approach. Results Thoracoscope was completed in 25 cases and there were 2 postoperative deaths.And 23 cases underwent extra-pleural esophageal anastomosis and another 2 had a ligation of tracheoesophageal fistula and gastrostomy because of excessively long gaps and 2 cases abandoned postoperative treatment.The mean operative duration was 127 (110 160) min for thoracoscopic approach versus 133 (105 170) min for thoracotomy.The mean time to extubation was 2.6 (1 13) versus 2.3 (1 11) days.There were no statistical significance.The anastomotic leak rate was both at 8% in two groups.The stricture rate was 28% versus 16% for closed and open techniques respectively.The relapse rate of TEF was 8% in thoracoscopic group while none in open group.There was no statistical significance. Conclusions The thoracoscopic technique is safe and feasible for both EA and TEF.However, surgeons must learn the mini-invasive techniques and acquire the relevant operative skills. Key words: Thoracoscopy; Esophageal atresia; Tracheoesophageal fistula