Page 38 - Jourmal of World Association of Laparoscopic Surgeon

Usman Javaid

in both groups and there was no difference in the duration and two patient developed high right shoulder deformity;
of mechanical ventilation and ICU stay. Preliminary studies however no literature showed any of this complication in
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by Mark Bishay et al showed no difference in pCO but thoracoscopic patients operated for EA with TEF.
2
mentioned that thoracoscopy may be associated with There are two main factors of survival/prognosis for
acidosis and decreased cerebral hemoglobin oxygenation neonates with EA with TEF, birth weight and presence of
saturation measured by near infra-red spectroscopy but still major cardiac anomalies. Infants with birth weight less than
it is not clear and need more data. 1,500 gm had 20% less chance of survival compared with
The operative time is always long in MAS due to two those weighting more than 1,500 gm at birth. Similarly,
factors, firstly the MAS is by default a slow surgery and infants with a major cardiac anomaly had 20% higher
secondly due to the learning curve. A detailed study done mortality this is independent to surgical approach. 32
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by David et al of thoracoscopic repair of EA with TEF
over 10 years, in which they have divided the thoracoscopy CONCLUSION
repair of EA with TEF in two periods of 5-year each. In all This multi-institutional review provide a recent comparison
10 years the duration of operative time remained unchanged. of approach to EA with TEF without any worse effect of
Initially due to learning curve and in second half the other thoracoscopy and compete well with traditional open
members and fellows principally performed surgery under thoracotomy approach. There is dramatic advancement of
the supervision of the senior surgeon which again leads to pediatric MAS over the last decade and the results are
same operative time. comparable with open thoracotomy in perioperative,
Almost all literature mentioned postoperative postoperative and long-term outcome with potential
anastomotic leak, which related to many factors from advantages of less scar tissue, less postoperative pain, less
preoperative to postoperative patient course, but majority disruption of anatomy and function and better cosmesis with
of these patient need conservative management. The markedly reduced musculoskeletal complication.
anastomotic leak was almost same in both groups with Thoracoscopic repair is a promising adjunct, but the
average of 10 to 27%. 4-8,13-16 All the leak was mentioned difficulties for setting it as the open thoracotomy still need
minor leak and healed by conservative management.
Another strong association EA with TEF is with more subjective studies with the consideration of learning
gastroesophageal reflux and is common problem after repair. curve and long surgical time. However, thoracoscopic repair
This incidence of reflux is related to esophagus dysmotility, of EA with TEF is a favorable and effective procedure with
26
delayed gastric emptying, there was controversy about the good prognosis.
optimal treatment between nonoperative management to REFERENCES
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