Thoracoscopic versus open repair of tracheoesophageal fistula and esophageal atresia

Background/Objective: Recent studies show the minimally invasive approach to the repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) is feasible. This study aimed to evaluate the efficacy and safety of the thoracoscopic versus open techniques. Methods: We performed a retrospective review of EA/TEF cases from June 2000 to July 2006. Patient characteristics, operative time, blood loss, duration of narcotic usage, time to extubation, time to first oral feeding, length of stay, complications, and follow-up were analyzed. Results: Thirty-five type-C EA/TEF patients were evaluated. Two patients with excessively long gaps who required esophageal " bougienage" stretching were excluded. Twenty-five patients underwent traditional repair through thoracotomy. There were 8 thoracoscopic attempts, 7 of which were successfully completed without a conversion. The mean operative time was 130 minutes (range, 75-240) for the thoracoscopic approach, compared to 123 (range, 82-205) for the thoracotomy; mean duration of narcotic use was 5 days (range, 1-12), as compared to 23 (range, 2-190); the mean time to extubation was 4.6 days (range, 1-12), compared to 19 (range, 3-150); the mean days to per os feeding were 9.8 days (range, 7-17) versus 37 (range, 7-360); and the mean length of stay was 21.8 days (range, 11-38), compared to 66 (range, 8-280). There were no intraoperative complications or deaths in either group. The anastomotic leak rate was 14 versus 20%, whereas the stricture rate was 14 versus 50% for the closed and open techniques, respectively. Of the thoracoscopic group, 87.5% had at least one major associated anomaly, compared with 70% of patients undergoing thoracotomy. Follow-up for the thoracoscopic and open groups were 18 and 28 months, respectively. Conclusion: Our results suggest that the outcomes of the thoracoscopic technique are comparable to that of the open technique. However, the number is small, and more data are needed to further evaluate the procedure.