Association of operative approach with outcomes in neonates with esophageal atresia and tracheoesophageal fistula
Topic overview
Retrospective analysis of 855 neonates with EA/TEF found thoracoscopic repair used in only 15.6% of cases with a 53% conversion rate to open surgery. Perioperative outcomes were similar between approaches except for longer operative time with thoracoscopy, while cardiac comorbidities and ventilator dependence were key predictors of adverse events.
Key takeaways
- Thoracoscopic EA/TEF repair has a 53% conversion rate to open surgery, suggesting technical challenges in neonatal cases.
- Operative time is significantly longer for thoracoscopic approach (217 min vs 180 min), but other perioperative outcomes are similar.
- Major cardiac comorbidities and preoperative ventilator dependence are the primary risk factors for adverse events, not surgical approach.
- Only 15.6% of neonatal EA/TEF repairs are attempted thoracoscopically, indicating limited adoption despite minimally invasive trends.
- Full-term infants are more likely to undergo thoracoscopic repair, suggesting patient selection influences approach choice.
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