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The largest report on thoracoscopic surgery for recurrent tracheoesophageal fistula after esophageal atresia repair

  • Author Footnotes
    1 These authors contributed equally to this work.
    Kaiyun Hua
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Neonatal Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing 100045, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Shen Yang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Neonatal Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing 100045, China
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  • Qiang Tao
    Affiliations
    Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang 330006, China
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  • Kuai Chen
    Affiliations
    Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang 330006, China
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  • Zhi Yang
    Affiliations
    Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang 330006, China
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  • Peize Wang
    Affiliations
    Department of Neonatal Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing 100045, China
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  • Yanan Zhang
    Affiliations
    Department of Neonatal Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing 100045, China
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  • Yong Zhao
    Affiliations
    Department of Neonatal Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing 100045, China
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  • Yichao Gu
    Affiliations
    Department of Neonatal Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing 100045, China
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  • Shuangshuang Li
    Affiliations
    Department of Neonatal Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing 100045, China
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  • Junmin Liao
    Affiliations
    Department of Neonatal Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing 100045, China
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  • Jinshi Huang
    Correspondence
    Corresponding author at: Department of Neonatal Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing 100045, China.
    Affiliations
    Department of Neonatal Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing 100045, China

    Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang 330006, China
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  • Author Footnotes
    1 These authors contributed equally to this work.

      Abstract

      Background

      Although thoracoscopic surgery has become the routine surgical method for esophageal atresia/tracheoesophageal fistula (EA/TEF), thoracoscopic treatment for recurrent tracheoesophageal fistula (rTEF) is far from popularized.

      Objectives

      We aimed to explore the safety and efficacy of thoracoscopic treatment for rTEF with a large-cohort study.

      Methods

      We retrospectively analyzed the clinical characteristics and outcomes of 103 consecutive patients who underwent thoracoscopic surgery for rTEF by one surgeon after EA/TEF repair at two different institutions in China from 2014 to 2021.

      Results

      One hundred and three pediatric patients (67 boys) were enrolled and the primary operations were performed via thoracoscopic (n = 75, 72.82%) or open surgery (n = 28, 27.18%). The median age at rTEF diagnosis was 5 (3, 10) months after the primary repair. Patients were diagnosed with recurrent fistula to the trachea (n = 97, 94.17%), bronchi (n = 4, 3.88%), and lung parenchyma (n = 2, 1.94%), and all of them underwent thoracoscopic surgery at a median age of 7 (5, 14) months with a median weight of 6200 (4870, 7650) g. After the repair of rTEF, the incidence of esophageal leakage, esophageal stricture, and TEF recurrence were 12.8%, 33.4%, and 10.8%, respectively. After the follow-up, 87 patients survived, 6 died, and 10 were lost to follow-up.

      Conclusions

      The results of thoracoscopic surgery for rTEF were comparable with previously reported thoracotomy surgery. Owing to the clear field during the operation, rapid patient recovery and esthetic results, the thoracoscopic approach could be a better choice for experienced pediatric surgeons.

      Level of Evidence

      LEVEL IV

      Keywords

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