Association of Operative Approach With Postoperative Outcomes in Neonates Undergoing Surgical Repair of Esophageal Atresia and Tracheoesophageal Fistula

Infographic · Dec 2024 · 1 min read

In brief

Propensity-matched analysis of 1738 neonates found minimally invasive EA/TEF repair associated with longer operative times and higher reintervention rates compared to open approach, despite similar composite morbidity. Study highlights need for further evaluation of MIS outcomes in this population.

Minimally invasive surgery for EA/TEF repair is associated with longer operative times (209 vs 174 min) compared to open approach.
MIS approach shows higher reintervention rates (7.6% vs 2.9%) but similar overall composite morbidity to open repair.
Use of minimally invasive techniques for EA/TEF repair has increased over time despite higher reintervention rates.
Propensity-matched analysis found no difference in composite morbidity between MIS and open EA/TEF repair (24.4% vs 25.0%).

Written by the GCMD Library team from the infographic.

A three-column comparison layout with illustrated diagrams of surgical procedures. Each column contains anatomical drawings showing the esophagus and surgical technique, accompanied by outcome statistics. Color-coded sections distinguish the three approaches, with icons representing success metrics and complication rates below each procedure illustration.

Paulo Castro, Fari Fall, Devon Pace, Shale J Mack, David H Rothstein, Courtney L Devin, Emily Sagalow, Allison F Linden, Matthew Boelig, Lindsey Asti, Loren Berman

Introduction: Minimally invasive surgery (MIS) is gaining traction as a first-line approach to repair congenital anomalies. This study aims to evaluate outcomes for neonates undergoing open versus MIS repairs for esophageal atresia/tracheoesophageal fistula (EA/TEF).

Methods: In this retrospective study, neonates undergoing EA/TEF repair from 2013 to 2020 were identified using the National Surgical Quality Improvement Program-Pediatric database. Proportions of operative approach (open vs. MIS) over time were analyzed. A propensity score-matched analysis using preoperative characteristics was performed and outcomes were compared including composite morbidity and reintervention rates (overall, major [thoracoscopy, thoracotomy], and minor [chest/feeding tube placement, endoscopy]) between operative approaches. Pearson's chi-square or Fisher's exact tests were used as appropriate.

Results: We identified 1738 neonates who underwent EA/TEF repair. MIS utilization increased over time. Pre-match, neonates undergoing open repair were more likely to be premature, lower weight, ventilator dependent, and have cardiac risk factors with higher severity. Post-match, the groups were similar and included 340 neonates per group. MIS repair was associated with longer median operative time (209 vs. 174 min, p < 0.001) and increased overall post-operative intervention rates (7.6% vs. 2.9%, p = 0.01). There were no differences in composite morbidity (24.4% vs. 25.0%, p = 0.86) outside of reintervention.

Conclusion: MIS approach for neonates with EA/TEF appears to be associated with a higher rate of reinterventions. Further studies evaluating MIS approaches for the repair of EA/TEF are needed to better define short- and long-term outcomes.

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