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TÜRKÇE
Oral Presentation - 41
PURE ESOPHAGEAL ATRESIA: COMPARISON OF THORACOTOMY VS. THORACOSCOPY
N Newland*, J Snajdauf*, A Kokesova*, S Coufal**, J Styblova*, M Rygl*
*Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
**Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the Czech Academy of Sciences
Purpose:
This study compares outcomes of thoracotomy and thoracoscopy in the treatment of pure esophageal atresia (EA).
Method:
A retrospective analysis of perinatal characteristics, surgical procedures and complications comparing thoracotomy and thoracoscopy for pure EA performed between 2011-2022. Thoracoscopy was the preferred surgical procedure from 2018. Statistical calculations were done using Mann-Whitney and Fisher's exact tests with significance level <0.05.
Results:
Of 264 patients operated for EA in the 12-year period, 22 patients were treated for pure EA (Gross type A). All patients underwent gastrostomy insertion after birth. Gastric interposition was performed in four patients (18%) as the final procedure and they were excluded from further analysis. Eighteen patients underwent a staged repair via thoracotomy (n=9) or thoracoscopy (n=9). Techniques used in the thoracotomy group included delayed primary repair, Foker procedure and internal traction, and in the thoracoscopy group, internal traction. Thoracotomy required less procedures to anastomosis (median [2; 3], p=0.0213) and shorter total operative time (median [169mins; 326mins], p=0.0007). Leakage was more frequent in the thoracotomy group (33%, 0%, p=0.2059), but stricture formation, number of dilatations and future fundoplication were comparable in both groups (66%, 66%, p>0.9999; median [0; 1], p=0.518; 11% and 0%, p>0.9999). Musculoskeletal deformities were more common in the thoracotomy group (38%, 0%, p=0.0824), however their follow-up was longer (median [92months; 52months], p=0.0206). Weight and height at one year were comparable in both groups (median [8000g; 8060g], p=0.559; median [68.5cm; 72cm], p=0.3312).
Conclusion:
In our study, thoracotomy required less operations and shorter total operative time to anastomosis creation but led to more postoperative and long-term complications. Thoracoscopy had a longer operative time but was safe in all other analysed parameters.