Comparison of respiratory outcomes between open and thoracoscopic tracheoesophageal fistula repair in neonates: an observational nonrandomized study

Background Tracheoesophageal fistula (TEF) is one of the most common congenital malformations of the esophagus. Open thoracotomy (OT) has long been considered the gold standard for the repair of this malformation. Recent reports have indicated that thoracoscopic repair (TR) is a safe and effective treatment alternative. This study aimed to demonstrate whether TR offers advantages in relation to perioperative respiratory outcomes. Patients and methods This study was conducted on 60 neonate patients (31 males and 29 females, aged 1–14 days) undergoing TEF repair from September 2022 to August 2023. The patients were divided into two groups: OT group and TR group. Each group had 30 patients. Epidural analgesia was administered to all patients by a caudally inserted epidural catheter. Preductal oxygen saturation (SaO2%), arterial blood gas and PF ratio (PaO2/FiO2), surfactant protein D (SP-D) level, incidence of acute lung injury, and postoperative atelectasis and respiratory distress (according to Downes score) were compared between the two groups. Results Postoperative SP-D values were significantly higher than preoperative values in the OT group. This correlates with the postoperative significant decrease in mean oxygen saturation and mean PF ratio and significant increase in Downes score in the OT group than in the TR group (P < 0.001, P < 0.001, P < 0.001 and 0.0075, respectively). Conclusion When compared with OT, TR of TEF is associated with less incidence of oxygen desaturation, postoperative atelectasis, postoperative respiratory distress, and acute lung injury. The only significant drawback of TR is the increase in end-tidal carbon dioxide tension intraoperatively.