Neonatal Thoracotomy Has 25% Chance of Chest Wall Deformity
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Key Takeaways
- 25% of neonates develop chest wall deformities after open thoracotomy for esophageal atresia repair (median 8-year follow-up)
- Muscle-sparing thoracotomy reduces deformity risk to 16% vs 55% with non-muscle-sparing technique
- Division of serratus anterior muscle significantly increases musculoskeletal deformity risk independent of other factors
- Long-term multidisciplinary follow-up is essential to detect and manage post-thoracotomy chest wall deformities
- Minimally invasive thoracoscopic approach may further reduce musculoskeletal complications compared to open surgery
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This is Todd Ponksy with the journal of pediatric surgery and here's your two minute review. Today we're going to review a study that's titled musculoskeletal deformities following neonatal thoracotomy, long-term follow-up of an esophagial atresia cohort. The first author is Dr. Way, and the senior author is Dr. Sharif Hamil, and the study was published out of Montreal Children's Hospital. So, one major argument for minimally invasive thoracic surgery is that open thoracotomies in neonates can lead to long-term chest wall deformities. However, the actual incidence of this has never really been shown. So, this study explored the incidence of musculoskeletal deformities in patients who underwent open repair of esophageal atresia between 1997 and 2012. And then subsequently received longitudinal follow-up in a multidisciplinary esophageal atresia clinic. None of the patients had any other predisposition to musculoskeletal deformities. Detailed chest wall and musculoskeletal exams were performed at each visit. The incident rate and incident rate ratios were used to determine the incidence of deformities. Logistic regression methods were used to test the effect of independent variables including sex, gestational age, muscle division, number of thoracotomies, and operative complications on the occurrence of musculoskeletal deformities. So, what they found after studying a cohort consisted of 52 patients and a median follow-up of eight years. Musculoskeletal deformities developed in 25% of patients. Non muscle sparing had a 55% chance of deformity, while muscle sparing had a 16% chance of deformity. Division of the serratus anterior was associated with significantly higher probability of developing musculoskeletal deformities even after adjusting for possible confounding variables. So, the take home message is that musculoskeletal deformities develop in a significant portion of neonates following thoracotomy. And a muscle sparing technique decreases the incidence of these deformities, and probably in minimally invasive thoracoscopic surgery as well. We hope you enjoyed this review. Please leave your comments and questions below. We'll see you next time. Thanks.