Respiratory morbidity and growth after open thoracotomy or thoracoscopic repair of esophageal atresia

• Published in: Journal of pediatric surgery 2012-11, Vol.47 (11), p.1975-1983
• Main Authors: Spoel, Marjolein, Meeussen, Conny J.H.M, Gischler, Saskia J, Hop, Wim C.J, Bax, Nikolaas M.A, Wijnen, Rene M.H, Tibboel, Dick, de Jongste, Johan C, IJsselstijn, Hanneke
• Format: Article
• Language: English
• Subjects: Child Development; Child, Preschool; Esophageal atresia; Esophageal Atresia - physiopathology; Esophageal Atresia - surgery; Follow-Up Studies; Functional Residual Capacity; Gastroesophageal Reflux - etiology; Humans; Infant; Infant, Newborn; Lung Diseases - diagnosis; Lung Diseases - etiology; Maximal Expiratory Flow Rate; Pediatric lung disease; Pediatrics; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Respiratory measurement; Surgery; Thoracoscopy; Thoracotomy; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2012.07.044

Abstract Background Respiratory morbidity has been described in patients who underwent repair of esophageal atresia as a neonate. We compared the influence of open thoracotomy or thoracoscopy on lung function, respiratory symptoms, and growth. Methods Functional residual capacity (FRCp ), indicative of lung volume, and maximal expiratory flow at functional residual capacity (V′maxFRC ), indicative of airway patency, of 37 infants operated for esophageal atresia were measured with Masterscreen Babybody at 6 and 12 months. SD scores were calculated for V′maxFRC. Results Repair was by thoracotomy in 21 cases (57%) and by thoracoscopy in 16 cases (43%). Lung function parameters did not differ between the types of surgery (FRCp ; P = .384 and V′maxFRC ; P = .241). FRCp values were in the upper normal range and increased from 6 to 12 months (22.5 and 25.4 mL/kg respectively, P = .010). Mean (SD) V′maxFRC was below the norm without significant change in SD scores from 6 to 12 months (− 1.9 and − 2.3, respectively, P = .248). Neither lung function nor type of repair was associated with clinical evolution up to 2 years. Conclusion Lung function during the first year was similar in EA infants repaired by thoracotomy or thoracoscopy. Ongoing follow-up including pulmonary function testing is needed to determine whether differences occur at a later age in this cohort.