Abstract
Background/purpose
Controversy persists regarding the ideal surgical approach for repair of esophageal
atresia with tracheoesophageal fistula (EA/TEF). We examined complications and outcomes
of infants undergoing thoracoscopy and thoracotomy for repair of Type C EA/TEF using
propensity score-based overlap weights to minimize the effects of selection bias.
Methods
Secondary analysis of two databases from multicenter retrospective and prospective
studies examining outcomes of infants with proximal EA and distal TEF who underwent
repair at 11 institutions was performed based on surgical approach. Regression analysis
using propensity score-based overlap weights was utilized to evaluate outcomes of
patients undergoing thoracotomy or thoracoscopy for Type C EA/TEF repair.
Results
Of 504 patients included, 448 (89%) underwent thoracotomy and 56 (11%) thoracoscopy.
Patients undergoing thoracoscopy were more likely to be full term (37.9 vs. 36.3 weeks
estimated gestational age, p < 0.001), have a higher weight at operative repair (2.9 vs. 2.6 kg, p < 0.001), and less likely to have congenital heart disease (16% vs. 39%, p < 0.001). Postoperative stricture rate did not differ by approach, 29 (52%) thoracoscopy
and 198 (44%) thoracotomy (p = 0.42). Similarly, there was no significant difference in time from surgery to stricture
formation (p > 0.26). Regression analysis using propensity score-based overlap weighting found
no significant difference in the odds of vocal cord paresis or paralysis (OR 1.087
p = 0.885), odds of anastomotic leak (OR 1.683 p = 0.123), the hazard of time to anastomotic stricture (HR 1.204 p = 0.378), or the number of dilations (IRR 1.182 p = 0.519) between thoracoscopy and thoracotomy.
Conclusion
Infants undergoing thoracoscopic repair of Type C EA/TEF are more commonly full term,
with higher weight at repair, and without congenital heart disease as compared to
infants repaired via thoracotomy. Utilizing propensity score-based overlap weighting
to minimize the effects of selection bias, we found no significant difference in complications
based on surgical approach. However, our study may be underpowered to detect such
outcome differences owing to the small number of infants undergoing thoracoscopic
repair.
Level of evidence
Level III.
Keywords
Abbreviations:
EA (Esophageal atresia), TEF (Tracheoesophageal fistula)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 24, 2022
Accepted:
September 16,
2022
Received:
August 26,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
