Esophageal anastomotic caliber index: assessment tool for measuring outcome after thoracoscopic and open repair of esophageal atresia with trachea-esophageal fistula

Abstract

Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula (TREAT) is now an established procedure. The anastomosis performed thoracoscopically is always compared to the hand sewn anastomosis in open surgery. The present study analyses the outcome of TREAT versus open repair in terms of radiological index representing the esophageal calibre. Patients with esophageal atresia-tracheoesophageal fistula (EA-TEF) operated by open repair and TREAT were evaluated. An esophageal calibre anastomotic index (EACI) was formulated based on measurements performed on contrast esophagogram at 3 months or later. The diameter of the esophagus at the level of anastomosis was measured, along with ratios of radiologically measured values both above and below the anastomosis; based on which an index was calculated. A value closer to 1 was considered normal, whereas a ratio < 0.65 was taken as cut off for stricture. This index calculated from the open and TREAT groups were compared. Total of 15 patients were enrolled in each group. The mean diameter ratio was calculated by measuring the breadth of contrast enhanced esophagus at three levels as described. The net EACI in the open and TREAT group was 0.779 ± 0.141 and 0.788 ± 0.217, respectively. The mean follow-up duration of these patients was 1.75 years ± 0.4 years. Clinical correlation was also done across the two groups and related well to the corresponding index. EACI is a numerical way to assess the calibre of esophageal anastomosis and has been found to correlate clinically. In the present study, there was no significant difference between the EACI of the two groups, demonstrating that thoracoscopic anastomosis are comparable to those performed open.