François Bastard1, Arnaud Bonnard2, Véronique Rousseau3, Thomas Gelas4, Laurent Michaud5, Sabine Irtan6, Christian Piolat7, Aline Ranke-Chrétien8, François Becmeur9, Anne Dariel10, Thierry Lamireau11, Thierry Petit12, Virginie Fouquet13, Aurélie Le Mandat14, Francis Lefebvre15, Hossein Allal16, Josephine Borgnon17, Julia Boubnova18, Edouard Habonimana19, Nicoleta Panait20, Philippe Buisson21, Marc Margaryan22, Jean-Luc Michel23, Jean Gaudin24, Hubert Lardy25, Frédéric Auber26, Corinne Borderon27, Philine De Vries28, Olivier Jaby29, Laurent Fourcade30, Jean François Lecompte31, Cécilia Tolg32, Benoit Delorme33, Françoise Schmitt34, Guillaume Podevin35. 1. University Hospital, 4 rue Larrey, 49933 Angers, France. Electronic address: Francois.Bastard@chu-angers.fr. 2. Robert Debré University Hospital, 48 bd Serrurier, 75019 Paris, France. Electronic address: arnaud.bonnard@rdb.aphp.fr. 3. Necker University Hospital, 149 rue de Sèvres, 75015 Paris, France. Electronic address: veronique.rousseau@nck.ap-hop-paris.fr. 4. Mère Enfant University Hospital, 59 bd Pinel, 69500 Bron, France. Electronic address: thomas.gelas@chu-lyon.fr. 5. Lille, Jeanne de Flandre University Hospital, Avenue Eugène Avinée, 59037 Lille, France. Electronic address: Laurent.MICHAUD@CHRU-LILLE.FR. 6. Trousseau University Hospital, 26 rue Arnold Netter, 75571 Paris Cedex 12. Electronic address: sabine.irtan@trs.aphp.fr. 7. Pôle Couple Enfant, Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France. Electronic address: cpiolat@chu-grenoble.fr. 8. Nancy University Hospital, 5 Rue du Morvan, 54500 Vandoeuvre-lès-, Nancy, France. Electronic address: a.ranke@chu-nancy.fr. 9. Hautepierre University Hospital 1 Avenue Molière, 67200 Strasbourg, France. Electronic address: francois.becmeur@chrustrasbourg.fr. 10. University Hospital, 7 quai Moncousu, 44000 Nantes, France. Electronic address: anne_dariel@yahoo.fr. 11. Pellegrin University Hospital, Place Amélie Raba Léon, 33000 Bordeaux, France. Electronic address: thierry.lamireau@chubordeaux.fr. 12. University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France. Electronic address: petit-t@chu-caen.fr. 13. University Hospital, 78, rue du Général Leclerc, 94275 Le Kremlin-Bicêtre. Electronic address: virginie.fouquet@bct.ap-hopparis.fr. 14. University Hospital, 330, Avenue de Grande Bretagne, 31059 Toulouse Cedex 9, France. Electronic address: lemandat.a@chutoulouse.fr. 15. American Memorial Hospital, 47 Rue Cognacq-Jay, 51092 Reims, France. Electronic address: flefebvre@chu-reims.fr. 16. Lapeyronie University Hospital, 371 Av. du Doyen Gaston Giraud, 34090 Montpellier, France. Electronic address: h-allal@chu-montpellier.fr. 17. University Hospital, 14 Rue Paul Gaffarel, 21000 Dijon, France. Electronic address: jborgnon@hotmail.com. 18. La Timone University Hospital, 264 Rue Saint-Pierre, 13385 Marseille, France. Electronic address: julia.boubnova@gmail.com. 19. Sud University Hospital, 16 Blv de Bulgarie, 35000 Rennes, France. Electronic address: edouard.habonimana@chu-rennes.fr. 20. Nord University Hospital, Chemin des Bourrely, 13915 Marseille Cedex 20, France. Electronic address: Nicoleta.PANAIT@aphm.fr. 21. Amiens University Hospital, Avenue Rene Laennec, 80480 Salouël, France. Electronic address: buisson.philippe@chu-amiens.fr. 22. Hospital Center, 194 Avenue Rubillard, 72037 Le Mans, France. Electronic address: mmargaryan@ch-lemans.fr. 23. Felix Guyon Hospital, Allée des Topazes, 97400, La Réunion, France. Electronic address: jean-luc.michel@chu-reunion.fr. 24. University Hospital, 2 rue de la Milétrie, 86000 Poitiers, France. Electronic address: j.gaudin@chu-poitiers.fr. 25. Clocheville University Hospital, 49, blvd Beranger, 37000 Tours, France. Electronic address: hubert.lardy@univ-tours.fr. 26. University Hospital, 2 Place Saint-Jacques, 25000 Besançon, France. Electronic address: fauber@chu-besancon.fr. 27. University Hospital, 58 Rue Montalembert, 63000 Clermont-Ferrand, France. Electronic address: cborderon@chuclermontferrand.fr. 28. University Hospital, 2 Avenue Foch, 29000 Brest, France. Electronic address: philine.devries@chu-brest.fr. 29. CHIC, 40 av Verdun, 94000, Créteil, France. Electronic address: olivier.Jaby@chicreteil.fr. 30. University Hospital, 2 Avenue Martin Luther King, 87000 Limoges, France. Electronic address: laurent.fourcade@chu-limoges.fr. 31. Lenval Hospital, 57 Avenue de la Californie, 06200, Nice, France. Electronic address: lecompte.j@pediatrie-chulenval-nice.fr. 32. University hospital, Fort-de-France, Martinique, France. Electronic address: Cecilia.Tolg@chu-fortdefrance.fr. 33. University Hospital, 4 rue Larrey, 49933 Angers, France. Electronic address: BeDelorme@chu-angers.fr. 34. University Hospital, 4 rue Larrey, 49933 Angers, France. Electronic address: FrSchmitt@chu-angers.fr. 35. University Hospital, 4 rue Larrey, 49933 Angers, France. Electronic address: gupodevin@chu-angers.fr.
Abstract
INTRODUCTION: Thoracotomy as surgical approach for esophageal atresia treatment entails the risk of deformation of the rib cage and consequently secondary thoracogenic scoliosis. The aim of our study was to assess these thoracic wall anomalies on a large national cohort and search for factors influencing this morbidity. MATERIALS AND METHODS: Pediatric surgery departments from our national network were asked to send recent thoracic X-ray and operative reports for patients born between 2008 and 2010 with esophageal atresia. The X-rays were read in a double-blind manner to detect costal and vertebral anomalies. RESULTS: Among 322 inclusions from 32 centers, 110 (34.2%) X-rays were normal and 25 (7.7%) displayed thoracic malformations, including 14 hemivertebrae. We found 187 (58.1%) sequelae of surgery, including 85 costal hypoplasia, 47 other types of costal anomalies, 46 intercostal space anomalies, 21 costal fusions and 12 scoliosis, with some patients suffering from several lesions. The rate of patients with these sequelae was not influenced by age at intervention, weight at birth, type of atresia, number of thoracotomy or size of the center. The rate of sequelae was higher following a classical thoracotomy (59.1%), whatever the way that thoracotomy was performed, compared to nonconverted thoracoscopy (22.2%; p=0.04). CONCLUSION: About 60 % of the patients suffered from a thoracic wall morbidity caused by the thoracotomy performed as part of surgical treatment of esophageal atresia. Minimally invasive techniques reduced thoracic wall morbidity. Further studies should be carried out to assess the potential benefit of minimally invasive approaches to patient pulmonary functions and on the occurrence of thoracogenic scoliosis in adulthood. LEVELS OF EVIDENCE: Level III retrospective comparative treatment study.
INTRODUCTION: Thoracotomy as surgical approach for esophageal atresia treatment entails the risk of deformation of the rib cage and consequently secondary thoracogenic scoliosis. The aim of our study was to assess these thoracic wall anomalies on a large national cohort and search for factors influencing this morbidity. MATERIALS AND METHODS: Pediatric surgery departments from our national network were asked to send recent thoracic X-ray and operative reports for patients born between 2008 and 2010 with esophageal atresia. The X-rays were read in a double-blind manner to detect costal and vertebral anomalies. RESULTS: Among 322 inclusions from 32 centers, 110 (34.2%) X-rays were normal and 25 (7.7%) displayed thoracic malformations, including 14 hemivertebrae. We found 187 (58.1%) sequelae of surgery, including 85 costal hypoplasia, 47 other types of costal anomalies, 46 intercostal space anomalies, 21 costal fusions and 12 scoliosis, with some patients suffering from several lesions. The rate of patients with these sequelae was not influenced by age at intervention, weight at birth, type of atresia, number of thoracotomy or size of the center. The rate of sequelae was higher following a classical thoracotomy (59.1%), whatever the way that thoracotomy was performed, compared to nonconverted thoracoscopy (22.2%; p=0.04). CONCLUSION: About 60 % of the patients suffered from a thoracic wall morbidity caused by the thoracotomy performed as part of surgical treatment of esophageal atresia. Minimally invasive techniques reduced thoracic wall morbidity. Further studies should be carried out to assess the potential benefit of minimally invasive approaches to patient pulmonary functions and on the occurrence of thoracogenic scoliosis in adulthood. LEVELS OF EVIDENCE: Level III retrospective comparative treatment study.
Authors: Moritz Markel; Gabrielle Derraugh; Martin Lacher; Shaikh Iqbal; Robert Balshaw; Suyin A Lum Min; Richard Keijzer Journal: Pediatr Surg Int Date: 2022-03-02 Impact factor: 1.827