Purpose: To evaluate the short-term safety and long-term efficacy of thoracoscopic surgery for esophageal atresia(EA) in low birth weight infants.
Methods: From January 2011 to December 2019,a retrospective analysis on clinical data of 48 cases of low birth weight infants of EA. The clinical data were divided according to surgical methods: Thoracoscopy group A and thoracotomy group B. Variables of intra-operation, postoperative complications and mid-term postoperative complications were compared between the two groups.
Results: 3 were discharged due to treatment abandoning. there were 17 cases in thoracoscopy group A and 28 cases in thoracotomy group B. The operation time of group A(172.41±20.00min)was longer than B(149.82±13.91min),the difference was statistically significant (P<0.05).the intraoperative blood loss of group A(7.41±2.83ml) was less than B(18.61±3.60ml),the difference was statistically significant (P<0.05).postoperative mechanical ventilation time, thoracic drainage time, hospital stay were not significantly different between the two groups. the incidence of anastomotic stenosis in group B(58.82%) was higher than in A(28.57%),the difference was statistically significant (P=0.045).There was no significant difference in the incidence of esophageal anastomotic fistula and recurrent tracheoesophageal fistula. After 3 years of follow-up, the incidence of thoracic deformity in group B(25%) was higher than in A(0%).The difference was significant(P=0.034).However, no significant difference was observed among the gastroesophageal reflux, symptomatic stenosis, tracheomalacia.
Conclusion: Compared with thoracotomy, thoracoscopy in low weight infants with EA has the advantages of smaller incision, fewer intraoperative bleeding, and less incidence of thoracic deformities. Thoracoscopy might be a feasible surgical option for low weight infants when performed by a surgeon who has rich experience. The major mid-term complications after surgery are esophageal stenosis, gastroesophageal reflux and tracheomalacia.