الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The first successful thoracoscopic repair of esophageal atresia was done in 1999 while the first successful total thoracoscopic lobectomy was reported in 2003. Considering the advanced endoscopic surgical skills required for these procedures, it took relatively long time until these procedures became popular among pediatric surgeons all over the world. The aim of this study was to evaluate the feasibility, the perioperative complications and the outcomes of these thoracoscopic procedures. Patients and Methods: This study was conducted on infants and children who underwent thoracoscopic treatment of Esophageal Atresia (EA) and Congenital Lung Malformations (CLMs) during the period from January 2013 to January 2020. Cases of bronchogenic cysts and extralobar sequestrations were excluded. In addition, patients with esophageal atresia in whom primary esophageal reconstruction was not possible were also excluded. Results: The study included 47 patients operated for type C EA and 90 patients operated for CLMs. There were two deaths among EA patients while no mortality occurred among CLMs patients. For esophageal atresia patients, the mean operative time was 128 minutes. Conversion to thoracotomy was required in 9% of patients. The median duration of mechanical ventilation was 4 days and the median duration of hospital stay was 25 days. Postoperative complications occurred in 42% of patients. The most frequently met complication was anastomotic stenosis that occurred in 33% of patients. Anastomotic leakage occurred in 9% of patients. For CLMs, the most commonly affected lung lobes were both lower lobes. The most common type of CLMs was CPAM (69%) followed by hybrid lesions (23%). In 31% of patients, there were previous attacks of respiratory infection. The median age at surgery was 17 months. Lobectomy was done in 21% of patients and sub-lobar resection in 79%. The median operative time was 96 minutes. Conversion to thoracotomy was required in 20% of cases. Postoperative complications occurred in 24% of patients. The most frequently encountered complication was prolonged air leak (14% of patients). The median duration of hospitalization was 4 days. Previous pulmonary infection before surgery was found to be associated with more complicated operative and postoperative courses in the form of longer operative time and higher conversion rate. Conclusion: Thoracoscopic management of esophageal atresia and congenital lung malformations is feasible despite being technically demanding. In experienced surgeons’ hands, thoracoscopic repair of esophageal atresia is a safe approach with good outcome even in preterm and low birth weight neonates. Thoracoscopic lung resection for CLMs is associated with a straightforward perioperative course. It is strongly recommended to propose early elective surgery for lesions that are highly liable for infection (cystic lesions and intralobar sequestrations) to achieve higher rates of success of the thoracoscopic approach.