Hyman Simone Carlson, Patwardhan Utsav, West Erin, Schermerhorn Sophia, Lee Joseph, Gollin Gerald
University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr., La Jolla, CA 92093, USA.
Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
J Pediatr Surg. 2025 Mar;60(3):162148. doi: 10.1016/j.jpedsurg.2024.162148. Epub 2024 Dec 31.
Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) has been reported to have superior outcomes to the open approach. We sought to evaluate adoption of thoracoscopic repair at US children's hospitals and compare outcomes to open repair.
The Pediatric Health Information System database was used to identify patients with EA/TEF who underwent repair between 2016 and 2023. Patients with birthweight less than 1800g and/or repair after the first 3 days of life were excluded. Postoperative complications, length of stay, and opioid requirements were assessed.
Inclusion criteria were met in 618 patients. Eighty thoracoscopic repairs were reported (13 %). The proportion of thoracoscopic operations did not change over the study period. Infants managed with a thoracoscopic or open approach were demographically similar. Thoracoscopic repair was associated with a higher incidence of anastomotic stricture (39 % vs. 26 %, p = 0.02), recurrent laryngeal nerve (RLN) injury (11 % vs 3 %, p = 0.001), and fewer days of postoperative opioid (5.2 vs. 6.5, p = 0.04). Other operative complications, LOS, and duration of TPN did not differ based on operative approach.
A small proportion of EA/TEF repairs in US children's hospitals were completed thoracoscopically and adoption of this approach did not increase between 2016 and 2023. Anastomotic stricture and RLN injury were significantly more likely after thoracoscopic repair. Although opioids were administered for one day fewer after thoracoscopic operations, no other metrics favored this approach. These data contrast with recent literature and suggest that the experience of high-volume hospitals may underestimate the morbidity of thoracoscopic EA/TEF repair and overestimate its benefits.
据报道，胸腔镜修复食管闭锁合并气管食管瘘（EA/TEF）的效果优于开放手术。我们旨在评估美国儿童医院采用胸腔镜修复的情况，并将其结果与开放修复进行比较。
使用儿科健康信息系统数据库识别2016年至2023年间接受EA/TEF修复的患者。排除出生体重小于1800g和/或出生后3天以上进行修复的患者。评估术后并发症、住院时间和阿片类药物需求。
618例患者符合纳入标准。报告了80例胸腔镜修复手术（13%）。在研究期间，胸腔镜手术的比例没有变化。采用胸腔镜或开放手术治疗的婴儿在人口统计学上相似。胸腔镜修复与吻合口狭窄发生率较高（39%对26%，p=0.02）、喉返神经（RLN）损伤发生率较高（11%对3%，p=0.001）以及术后阿片类药物使用天数较少（5.2天对6.5天，p=0.04）相关。其他手术并发症、住院时间和全胃肠外营养持续时间在手术方式上没有差异。
在美国儿童医院，一小部分EA/TEF修复手术是通过胸腔镜完成的，并且在2016年至2023年间这种方法的采用率没有增加。胸腔镜修复后吻合口狭窄和RLN损伤的可能性明显更高。虽然胸腔镜手术后阿片类药物使用少一天，但没有其他指标支持这种方法。这些数据与最近的文献形成对比，表明大型医院的经验可能低估了胸腔镜EA/TEF修复的发病率并高估了其益处。
