[Comparison of thoracoscopic and open repair of esophageal atresia with tracheoesophageal fistula].

BACKGROUND

With the increasing use of endoscopic surgery in children, several papers report the comparison between the thoracoscopic and open repair of the neonatal esophageal atresia with tracheoesophageal fistula (EA/TEF). Most of them focus on the duration and outcome of the surgery with few focusing on the neonatal tolerance to the thoracoscopic procedure and intraoperative anesthetic management.

METHODS

We retrospectively reviewed the repair surgery of EA/TEF performed during 2001 and 2006 in our institution and compared thoracoscopic repair (thoracoscopy group, n=5) with open repair (open group, n=7). The right main bronchus was blocked with Fogarty catheter in thoracoscopic repair, but not in open repair. Thoracoscopic repair was performed with insufflation of carbon dioxide (3-5 mmHg).

RESULTS

The thoracoscopy group had a higher incidence of intraoperative hypercapnia and acidosis and required higher inspired oxygen fraction. On admission to ICU Pa(CO2) was in the normal range in both groups and there was no difference in the duration of mechanical ventilation and ICU stay.

CONCLUSIONS

Hypercapnia and acidosis were severer in thoracoscopy group. Careful perioperative adjustment of inspired oxygen fraction and ventilator setting is required.