title: Thoracoscopic versus open repair of tracheoesophageal fistulas and rates of vocal cord paresis.
abstract: OBJECTIVE
  The purpose of this study was to investigate the rates of vocal cord paresis/paralysis (VCP) in patients treated for esophageal atresia (EA) with and without fistula performed thoracoscopically versus open.
  
  
  METHODS
  A retrospective review of EA cases performed from 2008 to 2014 in an integrated health care system was performed.
  
  
  RESULTS
  A total of 31 cases of EA were performed by 6 surgeons at 4 different institutions. Seventeen cases were performed thoracoscopically, whereas 14 cases were performed open. In the thoracoscopic group, the average gestational age (weeks) of the patient was significantly higher 38.3 vs. 35.2 (p=0.016) as well as the average birth weight (grams) 2843 vs. 2079 (p=0.005). There was no difference in the postoperative length of stay, rates of anastomotic stricture, leak, or tracheomalacia. There were 10 cases of vocal cord paresis, 9 from the thoracoscopic group and one from the open group (p=0.007). Of the 10 cases of VCP, 6 were unilateral (left sided) and 4 were bilateral. Of the 10 cases, 6 resolved, 2 resulted in permanent paralysis, and 2 are currently still being evaluated.
  
  
  CONCLUSIONS
  Thoracoscopic repair of EA appears to have higher rates of VCP. The results are thought to be from thoracoscopic dissection of the esophagus high into the thoracic inlet.
authors.affiliation: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Sunee
authors.initials: S
authors.lastname: Woo
authors.affiliation: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Lau
authors.affiliation: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Yoo
authors.affiliation: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Shaul
authors.affiliation: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA. Electronic address: Roman.M.Sydorak@kp.org.
authors.forename: Roman
authors.initials: R
authors.lastname: Sydorak
mesh_terms: D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013906:Thoracoscopy; D013908:Thoracotomy; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000453:epidemiology / Q000209:etiology*
keywords: Esophageal atresia; Infant; Pediatric; Thoracoscopy; Tracheoesophageal fistula; Vocal cord paralysis; Vocal cord paresis