Page 35 - Jourmal of World Association of Laparoscopic Surgeon

WJOLS

10.5005/jp-journals-10033-1179
REVIEW ARTICLE Is Minimal Access Surgery of Esophageal Atresia with Distal Esophageal Atresia by Thoracoscopy is
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

Usman Javaid

ABSTRACT Thoracoscopy is better than Conventional Thoracotomy?
A Multi-institutional Review of Literature to get the Answer. World
Topic: Is minimal access surgery of esophageal atresia with J Lap Surg 2013;6(1):37-41.
tracheoesophageal fistula by thoracotomy better than conven-
tional thoracotomy? A multi-institutional review of literature. Source of support: Most of the center have changed the
surgical approach for esophageal atresia with distal esophageal
Objective: Minimal access surgical technique has been one of
the most important surgical advances in the last few decades; atresia from open traditional thoractomy to minimal access
we have reached now in such era that complex neonate surgical surgery by thoracoscopic repair (references: 2, 12, 13, 14, 16).
issue can be addressed safely by minimal access surgery Conflict of interest: There is also debate that traditional
without significant morbidity. Esophageal atresia (EA) with distal approach of tracheoesophageal atesia with distal esophageal
tracheoesophageal fistula (TEF) has been successfully treated fistula by thoracotomy as described by Burford M concluded as
by traditional thoracotomy, but now the trend has been shifted complication rates similar to thoracoscopic repair but increased
toward minimal access surgery via thoracoscopic repair of EA rate of anastomotic leaks and greater need of anti reflux surgery.
with distal EA. The quest of this multi-institutional review is to However no musculoskeletal sequelae were directly attribute
get the answer that is minimal access surgery is better than the to thoracotomy.
traditional open approach.
Materials and methods: A literature view was performed from INTRODUCTION
2005 to 2012 using the PubMed, science direct, OVID search
EBSCOhost and search engines Google and Yahoo. The Esophageal atresia (EA), with or without tracheoesophageal
1
following search terms were used, thoracoscopic repair or fistula (TEF), occurs in three out of 1,000 live births. The
thoracoscopic surgery, thoracotomy and EA. most common anatomic variant of EA is the presence of a
Inclusion criterion is EA with distal esophageal fistula with
comparative study by open thoracotomy or by historical data. tracheal fistula to the distant remnant of the esophagus. This
Exclusion criteria were other esophageal anomalies. type of TEF occurs in 85% of all infants born with EA. The
Results: In 182 patients operated by minimal access surgery common anomaly has been traditionally operated by
by thoracoscopy, the mean gestational age, weight, associated classical right poster lateral thoracotomy. The first entirely
congenital anomalies, mechanical ventilation, perioperative thoracoscopic repair was reported by Lobe et al in 1999
2
pCO , postoperative early and late complication are comparable
2
with historical open thoracotomy. However MAS has a and described repair of EA in an 8-month-old patient.
3
superadded advantage in markedly reduction in scar tissue, Rothenberg has subsequently reported on a series of eight
postoperative pain and no chest wall deformity. neonates with EA and distal fistula operated thoracos-
Conclusion: This multi-institutional review provides a recent copically. With the advancement of minimal access surgery
comparison of the approached to EA with TEF without any worse in technology, engineering, fine instrument, optical
effect of thoracoscopy and competes well with traditional open magnification and surgical skill it provokes the pediatric
thoracotomy approach. There is dramatic advancement of
pediatric MAS over the last decade and the result are surgeons to use the minimal access surgery in pediatric
comparable with open thoracotomy in perioperative, patient. To date, there have been few literature published
postoperative and long-term outcome with potential advantages of thoracoscopic repair of EA with TEF. Still it is unclear
of less scar tissue, less postoperative pain, less disruption of
anatomy and function and better cosmoses with markedly how much beneficial is thoracoscopic approach. This study
reduced musculoskeletal complication. Thoracoscopic repair is describes the comparative results of 260 (Fig. 1) newborn
a promising adjunct, but there are difficulties for setting it as the babies from eight different institutes who underwent
open thoracotomy and it still needs more subjective studies with thoracoscopic repair of EA with TEF (Table 1) and
the consideration of learning curve and long surgical time.
However, thoracoscopic repair of EA with TEF is a favorable compared it with the open classical method of thoracotomy
and effective procedure with good prognosis. from recent and historical group (Table 2). 4-8
Keywords: Thoracoscopy, Minimal access surgery, Esophageal
atresia, Tracheoesophageal fistula. RESULTS

How to cite this article: Javaid U. Is Minimal Access Surgery The literature review from 2005 to 2012 were collected and
of Esophageal Atresia with Distal Esophageal Atresia by 61 articles were selected but only eight papers were selected
World Journal of Laparoscopic Surgery, January-April 2013;6(1):37-41 37