Tracheoesophageal fistula in the developing world: are we ready for thoracoscopic repair?
link.springer.com shows its articles on its own site.
Read the article on link.springer.com ↗Article · Mar 2020 · 1 min read
In brief
In brief
This review examines TEF management in low- and middle-income countries, finding that while surgical technique outcomes match developed nations, higher rates of sepsis and pneumonia persist. The authors provide a framework for assessing institutional readiness and implementing thoracoscopic repair in resource-limited settings.
Written by the GCMD Library team from the article.
Abstract
Purpose
Tracheoesophageal fistula (TEF) is a bellwether for a country’s ability to care for sick newborns. We aim to review the existing literature from low- and middle-income countries in regard to management of those newborns and the possible approaches to improve their outcomes.
Methods
A review of the existing English literature was conducted with the aim of assessing challenges faced by providers in LMIC in terms of diagnostic, preoperative, operative and post-operative care for TEF patients. We also review the limited literature for performing thoracoscopic repair in the developing world context and suggest methods for introduction of advanced thoracoscopic procedures including techniques for providing anesthesia to these challenging babies.
Results
While outcomes related to technique from LMIC are comparable to the developed world, rates of secondary complications like sepsis and pneumonia are higher. In many areas, repairs are conducted in a staged fashion with minimal utilization of thoracoscopic approach. The paucity of resources creates strain on intraoperative and post-operative management.
Conclusion
Clearly, not all developing world contexts are ready to attempt thoracoscopic repair but we outline suggestions for assessing the existing capabilities and a stepwise gradual implementation of advanced thoracoscopy when appropriate.