Transpleural versus extrapleural approach in treatment of esophageal atresia

Mohamed Batikhe

doi:10.1186/s43159-019-0015-7

Abstract

BackgroundSurgery is the only curative treatment of patients with esophageal atresia and tracheoesophageal fistula. A lot of surgeons recommend transpleural repair while others prefer extrapleural approach for repair. This study will evaluate the differences, advantages, outcome, and the disadvantages of the two techniques.ResultsDuration of surgery was significantly shorter in the group operated by transpleural approach. The incidence of pneumothorax was higher in patients operated by transpleural approach.ConclusionOperating esophageal atresia and tracheoesophageal fistula by transpleural approach has significantly shorter time of surgery, but there is no difference between the two groups as regards incidence of leakage or mortality.

Highlights

Surgery is the only curative treatment of patients with esophageal atresia and tracheoesophageal fistula
Neonates suffering from esophageal atresia and tracheoesophagial fistula type C were enrolled in this study, we divided patients randomly into two groups; surgery was done by extrapleural approach in group a, and in group b, we used transpleural one
The duration of surgery was significantly shorter in the group operated by transpleural approach (Table 3), and two patients suffered from pneumothorax on the right side after surgery; all cases were operated by transpleural approach and all improved after insertion of intercostal tube under water seal, left-sided pneumothorax occurred in one patient in extrapleural group who was under mechanical ventilation and responded to intercostal tube insertion

Summary

Introduction

Surgery is the only curative treatment of patients with esophageal atresia and tracheoesophageal fistula. Conclusion: Operating esophageal atresia and tracheoesophageal fistula by transpleural approach has significantly shorter time of surgery, but there is no difference between the two groups as regards incidence of leakage or mortality. Right posterolateral thoracotomy through extrapleural approach at 4th intercostal space is a common technique of surgery [1] It is difficult and needs much time to dissect pleura from chest wall, most of the surgeons prefer this approach more than transpleural technique, because the belief that empyema has less incidence if anastomotic leakage takes place, On the other hand, many surgeons believe that the outcome of the two techniques is the same while surgery by transpleural technique may be done more easy and faster [3]

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