Influence of thoracoscopic esophageal atresia repair on esophageal motor function and gastroesophageal reflux.
OBJECTIVE
Thoracoscopic repair has recently been attempted in newborns with esophageal atresia (EA), but it remains unclear whether thoracoscopic dissection reduces pathological gastroesophageal reflux. We investigated the influence of a thoracoscopic approach on esophageal motor function in patients with EA.


METHODS
Clinical and gastrointestinal data of 10 patients with EA with open repair (group A) and 7 with thoracoscopic repair (group B) were analyzed retrospectively. Videomanometry was conducted to investigate esophageal motor patterns. Esophageal acid exposure was evaluated with 24-hour esophageal pH monitoring. Data are expressed as medians and ranges.


RESULTS
Contractions in the distal esophagus were conspicuously absent in 1 and 3 patients in groups A and B, respectively (P = .26). There were no significant differences in esophageal acid exposure (5.5% [0.7%-24.6%] vs 3.7% [0.3%-56.8%]; P = .71) or mean esophageal acid reflux time (0.5 minutes [0.1-1.4 minutes] vs 0.5 minutes [0.1-1.3 minutes]; P = .87) between the 2 groups. Fundoplication was conducted in 2 patients in each group (P = .60), all of whom had conspicuously absent distal esophageal contractions. Those contractions were preserved in the remaining patients with the exception of 1 group B patient.


CONCLUSIONS
There are unlikely to be benefits from thoracoscopic repair of EA in terms of postoperative esophageal motor function.
Kawahara
Hisayoshi
H
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka 594-1101, Japan. kawahara@mch.pref.osaka.jp
Okuyama
Hiroomi
H
Mitani
Yasuyuki
Y
Nomura
Motonari
M
Nose
Keisuke
K
Yoneda
Akihiro
A
Hasegawa
Toshimichi
T
Kubota
Akio
A
Fukuzawa
Masahiro
M
D000714:Anastomosis, Surgical / Q000379:methods; D004933:Esophageal Atresia / Q000601:surgery*; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008365:Manometry / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome