EN
TÜRKÇE
Poster - 47
Thoracoscopic salvage surgery for oesophageal atresia is feasible after previous thoracotomy.
C Pardy*, D Borselle**, AS Martinho***, S Giuliani*, S Tytgat****, J Correia-Pinto***, A Bonnard*****, D Patkowski**, S Rothenberg******, P De Coppi*
*Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
**Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
***Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
****Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
*****Department of Pediatric Surgery, Robert-Debré Children's University Hospital, Paris, France
******Rocky Mountain Hospital for Children, Denver, CO, United States
Aim: to describe the collective experience of six international tertiary paediatric surgery centres performing thoracoscopic salvage surgery for oesophageal atresia.
Methods: retrospective review of all neonates undergoing thoracoscopic repair of oesophageal atresia following a previous failed repair via thoracotomy, from September 2018 - May 2024, at 6 international tertiary paediatric surgery centres. Data collected included demographics, co-morbidities, operative details and post-operative clinical course.
Results: 24 babies included. Median gestational age 34 (26-40), birthweight 1858g (780-3300). 11 (46%) had associated cardiac anomalies. 19 type C (79%), 4 type B (17%), 1 type A (4%). 7/24 (29%) had thoracoscopic traction sutures, and 2/24 (8%) had a cervical oesophagostomy formed prior to thoracoscopic repair. Definitive thoracoscopic repair was undertaken at median 23 weeks (7-23) after initial thoracotomy, at median age of 6 months (1-26) and weight of 5340g (1050-1100). Median operative time was 245 minutes (120-585). 23/24 (96%) were completed thoracoscopically. Follow-up was 36 months (7-130). 17/24 (71%) developed an oesophageal stricture requiring a median of 5 dilatations (1-45). 1 patient had a recalcitrant stricture resected thoracoscopically a year after definitive thoracoscopic repair. 2/24 (8%) developed a fistula to the airway. 1 patient developed a recurrent TOF requiring 3 bronchoscopic applications of TCA. A second patient developed a fistula to the right upper lobe bronchus requiring a thoracotomy for repair. 2/24 (8%) developed significant gastro-oesophageal reflux disease requiring a fundoplication. One patient required an aortopexy and re-do aortopexy for management of tracheomalacia. 1 death at 11 months of age (2 months post definitive repair) in a patient with complex congenital cardiac disease. 22/23 (96%) patients are feeding exclusively orally. 1 patient born at 26 weeks is feeding orally with gastric top-ups.
Conclusion: thoracoscopic salvage surgery in oesophageal atresia when undertaken by experienced surgeons is feasible, safe and with good clinical outcomes.