THORACOSCOPIC TREATMENT OF ESOPHAGEAL ATRESIA: 18-YEARS INTERNATIONAL EXPERIENCE IN 775 PATIENTS IN FIVE CHILDREN’S SURGERY CENTERS
Authors:   Irkutsk Oblast Regional Children's Clinical Hospital, Irkutsk, Russia, Kozlov Yu.A. ,   Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia,   Irkutsk State Medical University, Irkutsk, Russia, Kovalkov K.A. ,   Kemerovo City Children’s Clinical Hospital, Kemerovo, Russia, Kapuller V.M. ,   Hadassah - Hebrew University Medical Center, Jerusalem, Israel, Rothenberg S. ,   Rocky Mountain Hospital for Children, Denver, Colorado, USA, Razumovsky A.Yu. ,   Pirogov Russian National Research Medical University, Moscow, Russia, van der Zee D. ,   University Medical Center Utrecht, Utrecht, Netherlands, Patkowski D. ,   Uniwersytet Medyczny im. Piastów Śląskich we Wrocławiu, Wrocław, Poland, Narkevich A.N. ,   Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Krasnoyarsk Krai, Russia
Published: May 2021

The paper presents a synthesis of the multicenter retrospective comparative study of the treatment of patients with esophageal atresia (EA) from 5 children's hospitals located in different countries of the world. Materials and methods of research: The study examined the results of surgical treatment of 775 patients with EA who were treated in 5 children’s hospitals located in Russia, USA and Europe: Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk (Russia) – 126 patients; Children's Hospital of the Rocky Mountains, Denver (Colorado, USA) – 143, Pirogov Russian National Research Medical University, Moscow (Russia) – 175, University Medical Center, Utrecht (Netherlands) – 173, University of Medicine, Wroclaw (Poland) – 158 patients. The study lasted 18 years, from the very beginning of technology adoption in these hospitals and endied in December 2018 (from 2000 to 2018). In relation to patients, uniform technological methods of performing thoracoscopic anastomosis of the esophagus and recommendations for the postoperative management of such patients were applied, issued and controlled by all participants in this process. Results: in the analysis of treatment outcomes, mortality associated with surgery and mortality that had no causal link with surgery were considered. Mortality associated with surgical intervention in the presented treatment series did not differ statistically significantly and amounted to 0,8% (minimum – 0,0%, maximum – 1,7%, p=0,320). Non-operation fatalities varied statistically significantly and ranged from 0,0% to 4,4% (weighted average – 3,0%, p=0,030), but a pairwise comparison with the Benjamini-Hochberg amendment shows no statistically significant differences between the cities of the study. Anastomotic leakage (failure) rate was comparable and was detected in 5,8% of cases (minimum 2,9%, maximum 9,7%, p=0,059). Statistically significant differences were found in the following parameters: anastomotic stenosis developed in 10,3–39,9% of cases (weighted average – 20,1%, p<0,001); fistula recanalization was recorded in 2,7% of patients (minimum – 0,7%, maximum – 8,1%, p<0,001); the need for fundoplication existed in 14,3% of patients (minimum – 2,5%, maximum – 26,0%, p<0,001); the level of detection of tracheomalacia also differed in the presented treatment series and ranged from 0,0% to 9,2% (weighted average – 3,7%, p<0,001). Thus, the use of thoracoscopy for the treatment of EA ensures a low level of postoperative mortality, a low incidence of early and late postoperative complications. Conclusion: thoracoscopic EA reconstruction can be safely performed by experienced endoscopic surgeons from different centers, united by one technology for performing endosurgical operations in newborns and infants.