Thoracotomy vs. Thoracoscopy for Esophageal Atresia with Tracheoesophageal Fistula Repair: Is There a Difference in Quality of Life?

Aim: Esophageal atresia (EA) is the most common congenital esophageal malformation. Thoracoscopic repair is gaining popularity, but controversy persist regarding the ideal surgical approach for this challenging anomaly. Study’s aim is to analyze outcomes in terms of quality of life (QoL) of children undergoing thoracotomy and thoracoscopy for type III EA repair. Methods: Perinatal characteristics, malformations, surgical procedures, complications, gastrointestinal and respiratory current symptoms were collected. QoL were investigated through Esophageal-Atresia-QoL(EAQoL) and Pediatric-QoL(PedsQL)4.0 standardized and validated questionnaires. Statical Mann-Whitney test with significance level p <0.05 was carried out. Main results: A total of 32 patients undergoing type III EA primary repair answered the questionnaire, including 17 thoracotomy and 15 thoracoscopy. Median birth weight was not significantly different between two groups (median[2.385;2.475], p=.3529) while gestational age showed statistically difference (median[36;38], p=.0063). Thirty-five associated malformations (15 thoracotomy, 20 thoracoscopy) in 23 patients were observed. Postoperative complications occurred in 9 patients in thoracotomy group (1 recurrent fistula, 2 leakages, 6 stenosis) and in 6 patients in thoracoscopic group (2 recurrent fistula, 4 stenosis). Analyzing EAQoL we found statistically significant difference in physical health between the two groups (median[83;96], p=0.0119), while there was no difference in social relations, eating and total score (median[100;100], p=0.3473)(median[91;97], p=0.5749)(median[91;96], p=0.1710). Investigating PedsQL, psychosocial-health score (median[88;98], p=0.0069) and total score (median [91;99], p=0.0043) were statically significant different between the groups, whereas there was no difference for physical-health score (median[91;100], p=0.0706). Conclusions: Thoracoscopic EA repair is safe and feasible, allowing patient to have a better QoL in terms of physical and psychosocial health score.