Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States.
Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, United States; Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
J Pediatr Surg. 2024 Nov;59(11):161641. doi: 10.1016/j.jpedsurg.2024.07.026. Epub 2024 Jul 23.
Minimally invasive surgery (MIS) is gaining traction as a first-line approach to repair congenital anomalies. This study aims to evaluate outcomes for neonates undergoing open versus MIS repairs for esophageal atresia/tracheoesophageal fistula (EA/TEF).
In this retrospective study, neonates undergoing EA/TEF repair from 2013 to 2020 were identified using the National Surgical Quality Improvement Program-Pediatric database. Proportions of operative approach (open vs. MIS) over time were analyzed. A propensity score-matched analysis using preoperative characteristics was performed and outcomes were compared including composite morbidity and reintervention rates (overall, major [thoracoscopy, thoracotomy], and minor [chest/feeding tube placement, endoscopy]) between operative approaches. Pearson's chi-square or Fisher's exact tests were used as appropriate.
We identified 1738 neonates who underwent EA/TEF repair. MIS utilization increased over time. Pre-match, neonates undergoing open repair were more likely to be premature, lower weight, ventilator dependent, and have cardiac risk factors with higher severity. Post-match, the groups were similar and included 340 neonates per group. MIS repair was associated with longer median operative time (209 vs. 174 min, p < 0.001) and increased overall post-operative intervention rates (7.6% vs. 2.9%, p = 0.01). There were no differences in composite morbidity (24.4% vs. 25.0%, p = 0.86) outside of reintervention.
MIS approach for neonates with EA/TEF appears to be associated with a higher rate of reinterventions. Further studies evaluating MIS approaches for the repair of EA/TEF are needed to better define short- and long-term outcomes.
Retrospective comparative study.
Level III.
微创外科（MIS）作为先天性畸形修复的一线方法正在得到广泛应用。本研究旨在评估新生儿接受开放性与 MIS 修复食管闭锁/气管食管瘘（EA/TEF）的结果。
本回顾性研究使用国家外科质量改进计划-儿科数据库，确定了 2013 年至 2020 年期间接受 EA/TEF 修复的新生儿。分析了手术方法（开放性与 MIS）随时间的变化趋势。使用术前特征进行倾向评分匹配分析，并比较了两种手术方法的复合发病率和再干预率（总体、主要[胸腔镜、开胸]和次要[胸部/喂养管放置、内镜]）。采用 Pearson 卡方检验或 Fisher 确切检验。
我们共确定了 1738 例接受 EA/TEF 修复的新生儿。MIS 的使用率随时间增加。在匹配前，接受开放性修复的新生儿更可能是早产儿、低体重、依赖呼吸机和存在心脏危险因素，且严重程度更高。在匹配后，两组相似，每组包括 340 例新生儿。MIS 修复与更长的中位手术时间（209 分钟 vs. 174 分钟，p < 0.001）和更高的总体术后干预率（7.6% vs. 2.9%，p = 0.01）相关。复合发病率（24.4% vs. 25.0%，p = 0.86）除外再干预外，两组无差异。
对于 EA/TEF 新生儿，MIS 方法似乎与更高的再干预率相关。需要进一步研究 MIS 方法修复 EA/TEF 的效果，以更好地定义短期和长期结果。
回顾性比较研究。
III 级。
