الفهرس 
ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULAOnly 14 pages are availabe for public view
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Abstract
E
sophageal atresia (EA) and tracheoesophageal fistula (TEF) are rare congenital anomalies that affect approximately 1 in 2500-4500 live births. It results in difficulty breathing, choking, and aspiration of fluids into the lungs. These conditions require prompt surgical intervention to ensure proper feeding, prevent respiratory complications, and improve overall outcomes.
Traditionally, the surgical repair of EA and TEF has been performed using an open thoracotomy approach, which involves a large incision in the chest. While this technique has been effective in treating these conditions, it is associated with significant morbidity, including pain, scarring, and prolonged hospital stays. In recent years, minimally invasive techniques, such as thoracoscopy, have been developed as an alternative approach to repair EA and TEF.
Despite the potential benefits of thoracoscopic repair, this technique requires specialized training and expertise. Additionally, not all cases of EA and TEF may be amenable to thoracoscopic repair. Therefore, careful patient selection and assessment of the surgical approach are essential to ensure optimal outcomes.
In this work, we aim to evaluate the feasibility, safety, and effectiveness of thoracoscopic repair of EA and TEF in our centre, and to report the outcomes of our early experience with this technique.
Between January 2021 to January 2023, patients with established diagnosis of esophageal atresia (EA) & tracheoesophageal fistula (TEF) meeting the inclusion criteria of the study were offered thoracoscopic repair. Demographic data, preoperative investigations, operative data, intra or postoperative complications, as well as short-term follow up data were recorded. During the specified period, 16 patients underwent thoracoscopic repair (11 males & 5 females) with a median gestational age of 37 weeks (range from 35 to 40 weeks), and Mean birth weight of 2.6 kg (range from 2.1 to 3 kg). There was no conversion to open approach with operative time ranging from 105 to 150 minutes (Mean =125 ± 18 min) for cases of primary repair. The mean operative time for traction was 46 ± 3 minutes (range from 45 to 50 minutes). Only one case underwent delayed primary repair after traction on post operative day 6 with operative time of 135 minutes. No intraoperative complications were encountered.
Postoperative complications included anastomotic leakage in 7.7%, anastomotic stricture in 6.25%, GERD in 6.25%, No cases of recurrent TEF, mortality rate was 37.5%.
Limitations to our study were small cohort size, decreased use of thoracoscopy in our center during the COVID-19 era, lack of comparative groups with the conventional open repair which is the established technique in our center, and absence of long-term follow-up.
We concluded that thoracoscopic repair of EA can be performed safely, with good outcome and all the benefits of minimally invasive surgeries. However, it remains a challenging procedure with significant learning curve and should be performed only in pediatric centers having access to a multidisciplinary team of neonatologists, pediatric anesthesiologists, and pediatric surgeons to ensure the best possible care in hemodynamic and respiratory monitoring.
CONCLUSION AND RECOMMENDATIONS
W
e concluded that thoracoscopic repair of EA can be performed safely, with good outcome and all the benefits of minimally invasive surgeries. However, it remains a challenging procedure with significant learning curve and should be performed only in pediatric centers having access to a multidisciplinary team of neonatologists, pediatric anesthesiologists, and pediatric surgeons to ensure the best possible care in hemodynamic and respiratory monitoring.
Further studies are needed to assess the exact outcome of the procedure. More patients should be included. Longer follow up is needed for long term results and to detect any late complications. Comparative study with the established open technique is justified to compare outcome. Finally, a standardised training programme should be established for the trainees, in order to have experts in reasonable time, and before replacing the open technique by the thoracoscopic one as the standard procedure.