Comparative analysis of thoracoscopic and open extrapleural surgery in the treatment of neonatal type III esophageal atresia

Abstract

Abstract Objective To investigate the efficacy of both transthoracoscopic and open thoracic surgical approaches in the treatment of neonatal type III esophageal atresia, to compare the feasibility of the two surgical approaches and to provide a reference for clinical treatment. Methods Clinical data for 73 patients with type III esophageal atresia admitted to the Affiliated Hospital of Zunyi Medical University from January 2016 to December 2021 were retrospectively analyzed. The patients were divided into an open-chest group (n=21 patients) and a lumpectomy group (n=52 patients) according to the surgical method. Numerous perioperative observations and postoperative complication rates were compared between the two groups of children. Results Operating time [(156.10.10±9.02) min vs. (144.10±6.66) min], anesthesia time［（206.10.10±12.11）min VS（197.50±15.97）min］,surgical bleeding [(5.86±1.24) ml vs. (2.98±1.38) ml], and incision length [(6.68±0.56) cm vs. (1.12±0.16) cm] were significantly different between the open-chest and lumpectomy groups. Postoperative differences were statistically significant (P<0.05). Conversely, differences in length of postoperative hospital stay, postoperative drainage tube removal time, and postoperative complication rate between the two groups were not statistically significant (P>0.05). In the lumpectomy group, there were 11 cases of anastomotic stricture (21.15%), 9 cases of anastomotic leak (17.31%) and 3 cases of recurrent tracheo-esophageal fistula (5.77%). In the open group, there were 5 cases of anastomotic stenosis (23.81%), 4 cases of anastomotic leakage (19.05%) and 2 cases of tracheo-esophageal fistula recurrence (9.52%). The difference between the two groups was not statistically significant (P < 0.05). Conclusion Compared with the open-heart surgical approach, thoracoscopy is a safe and minimally invasive procedure for the treatment of type III CEA, and is advantageous in that the operative field is larger, the procedure is more precise and the postoperative recovery is faster.