title: Factors affecting postoperative respiratory tract function in type-C esophageal atresia. Thoracoscopic versus open repair.
abstract: OBJECTIVE
  We assessed the outcome of 72 cases of type-C esophageal atresia (EAc) treated by open (OR) or thoracoscopic (TR) repair from 2000 to 2013. During OR, direct lung retraction (DLR) is required but during TR, CO2 insufflation causes lung collapse so DLR is unnecessary.
  
  
  METHODS
  Patient demographics, operative time, respiratory tract impact (RTI: incidence of atelectasis, timing of extubation, need for reintubation, and duration of chest tube insertion), narcotic usage, commencement of oral feeding, and length of hospitalization (LOH) were compared.
  
  
  RESULTS
  Seven long-gap cases were excluded, leaving 65 EAc subjects (TR = 25, OR = 40). Patient demographics, operative time, and duration of chest tube insertion were similar. No TR case required DLR. Significant differences were found in TR for narcotic usage (1.6 vs. 3.1 days), commencement of feeding (7.8 vs. 10.5 days), incidence of atelectasis (8 vs. 30 %), initial extubation (2.8 vs. 5.6 days), and LOH (33 vs. 46 days), (all p < 0.05, respectively). Postoperative tracheal tube blockage caused by excessive secretions (4 vs. 10 %) and reintubation (4 vs. 17.5 %) were less in TR but not significant. There were three anastomotic leakages in TR, one in OR.
  
  
  CONCLUSIONS
  TR is less traumatic than OR because DLR is unnecessary, resulting in lower RTI and smooth recovery.
authors.affiliation: Department of Pediatric Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, h-koga@juntendo.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Masaya
authors.initials: M
authors.lastname: Yamoto
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.forename: Takashi
authors.initials: T
authors.lastname: Doi
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Koji
authors.initials: K
authors.lastname: Fukumoto
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Naoto
authors.initials: N
authors.lastname: Urushihara
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D004933:Esophageal Atresia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D012143:Respiratory Physiological Phenomena; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome