title: Current Practice and Outcomes of Thoracoscopic Esophageal Atresia and Tracheoesophageal Fistula Repair: A Multi-institutional Analysis in Japan.
abstract: BACKGROUND
  In order to better understand the current practice and outcomes of thoracoscopic repair of esophageal atresia (EA)/tracheoesophageal fistula (TEF), a multi-institutional analysis was conducted among seven Japanese institutes.
  
  
  METHODS
  A survey was sent to the seven institutes regarding the surgical technique, postoperative management, and outcomes of thoracoscopic repair of EA/TEF.
  
  
  RESULTS
  The operation was uniformly performed via an intrapleural approach in the 0-45° prone position. The TEF was occluded with suture ligature in four (57.1%) institutes and clips in the remaining three (42.9%) institutes. Anastomosis was performed using the extracorporeal knot-tying technique in four institutes and the intracorporeal technique in three institutes. Patients were routinely left intubated and paralyzed for 3-7 days postoperatively in four institutes. In total, 58 patients underwent thoracoscopic repair of EA/TEF. Fifty-two (89.7%) of the patients underwent successful thoracoscopic repair. Six (10.3%) operations were converted to open thoracotomy because of a long gap (n=4), right aortic arch (n=1), and intraoperative instability (n=1). The body weight at operation ranged from 1.2 to 4.6 kg, and the operative time ranged from 115 to 428 minutes. There were no major intraoperative complications. Eleven patients (19.0%) suffered from anastomotic leakage. Twenty-eight patients (48.3%) developed anastomotic stricture. One patient died during the postoperative period because of an unrelated disease. Recurrent TEF developed in three patients (5.2%). Thirteen patients (22.4%) later required fundoplication.
  
  
  CONCLUSIONS
  The outcome of thoracoscopic repair of EA/TEF was comparable to that of the open procedure. As considerable variability was observed among the seven institutes with respect to the surgical technique and management, standardizing the surgical management may improve the outcome.
authors.affiliation: 1 Department of Pediatric Surgery, Osaka University Graduate School of Medicine , Suita, Osaka, Japan .
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Okuyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ishimaru
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawashima
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
authors.forename: Naoto
authors.initials: N
authors.lastname: Urushihara
authors.forename: Osamu
authors.initials: O
authors.lastname: Segawa
authors.forename: Hiroo
authors.initials: H
authors.lastname: Uchida
authors.forename: Tadashi
authors.initials: T
authors.lastname: Iwanaka
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D061887:Conversion to Open Surgery; D004933:Esophageal Atresia / Q000601:surgery*; D018662:Fundoplication; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D061646:Operative Time; D016684:Prone Position; D012008:Recurrence; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D013906:Thoracoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013908:Thoracotomy; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome