Comparison between balloon dissection and conventional dissection for extrapleural approach in tracheoesophageal fistula repair

Abstract

Objective The extrapleural approach for tracheoesophageal fistula is preferred by most of the pediatric surgeons. The traditional method is based on combined blunt and sharp dissection. We compared this with dissection using Foley's catheter balloon. Patients and methods This study included two groups: the conventional dissection group, which included 30 cases, and the balloon group, which included 22 cases. Results The mean time for pleural dissection in the conventional group was 10 min, with a range of 8-15 min, whereas the mean in the balloon group was 4.5 min, with a range of 2-6 min. Minor pleural tears occurred in six cases (20%) in the conventional group versus four (18%) in the balloon group. Four major pleural tears were encountered in the conventional group (13.3%), which were managed with repair and intercostal tube insertion, whereas none of the balloon group cases showed major tears. Six anastomotic leaks occurred in the conventional group versus four in the balloon group, which were managed conservatively. Three mild anastomotic strictures (10%) occurred in the conventional group versus two in the balloon group (9%), and all were managed conservatively. Conclusion Balloon dissection is an efficient, rapid, and safe method for pleural dissection in the extrapleural approach for repair of tracheoesophageal fistula.