Is Minimal Access Surgery of Esophageal Atresia with Distal Esophageal Atresia by Thoracoscopy is better than Conventional Thoracotomy? A Multi-institutional Review of Literature to get the Answer

Abstract

Topic: Is minimal access surgery of esophageal atresia with tracheoesophageal fistula by thoracotomy better than conventional thoracotomy? A multi-institutional review of literature. Objective: Minimal access surgical technique has been one of the most important surgical advances in the last few decades; we have reached now in such era that complex neonate surgical issue can be addressed safely by minimal access surgery without significant morbidity. Esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) has been successfully treated by traditional thoracotomy, but now the trend has been shifted toward minimal access surgery via thoracoscopic repair of EA with distal EA. The quest of this multi-institutional review is to get the answer that is minimal access surgery is better than the traditional open approach. Materials and methods: A literature view was performed from 2005 to 2012 using the PubMed, science direct, OVID search EBSCOhost and search engines Google and Yahoo. The following search terms were used, thoracoscopic repair or thoracoscopic surgery, thoracotomy and EA. Inclusion criterion is EA with distal esophageal fistula with comparative study by open thoracotomy or by historical data. Exclusion criteria were other esophageal anomalies. Results: In 182 patients operated by minimal access surgery by thoracoscopy, the mean gestational age, weight, associated congenital anomalies, mechanical ventilation, perioperative pCO2, postoperative early and late complication are comparable with historical open thoracotomy. However MAS has a superadded advantage in markedly reduction in scar tissue, postoperative pain and no chest wall deformity. Conclusion: This multi-institutional review provides a recent comparison of the approached to EA with TEF without any worse effect of thoracoscopy and competes well with traditional open thoracotomy approach. There is dramatic advancement of pediatric MAS over the last decade and the result are comparable with open thoracotomy in perioperative, postoperative and long-term outcome with potential advantages of less scar tissue, less postoperative pain, less disruption of anatomy and function and better cosmoses with markedly reduced musculoskeletal complication. Thoracoscopic repair is a promising adjunct, but there are difficulties for setting it as the open thoracotomy and it still needs more subjective studies with the consideration of learning curve and long surgical time. However, thoracoscopic repair of EA with TEF is a favorable and effective procedure with good prognosis.