Thoracic musculoskeletal deformities are significant complications following open correction of esophageal atresia (EA) during long-term follow-up. We aimed to compare the frequency and severity of thoracic musculoskeletal deformities after open and thoracoscopic repair of EA. We hypothesized that fewer deformities would occur following the less invasive thoracoscopic approach. This retrospective study analyzed patients treated at two pediatric surgery departments in Poland between 2005 and 2021. The patient groups differed in surgical approach, operative techniques, indications for multi-staged surgery, and postoperative complications. The study encompassed all types of EA/TEF. The first group comprised 68 patients who underwent thoracoscopic esophageal atresia repair (Wroclaw), while the second group involved 44 patients who underwent open repair (Warsaw). Clinical data were retrospectively reviewed, with results considered significant at p < 0.05. The median age at examination was 6 years in the thoracoscopy group and 5.5 years in the thoracotomy group. In the thoracoscopy group, 53 out of 68 patients (77.9%) and in the thoracotomy group – 35 out of 44 patients (79.5%) were treated in one stage. The incidence of thoracic musculoskeletal deformities was significantly lower in the thoracoscopy group (1.5%) compared to the thoracotomy group (34.1%, p < 0.001). Scoliosis occurred significantly more often after thoracotomy (13.6% vs 1.5%, p = 0.016). There was no rib fusion (0% vs 37.1%, p < 0.001) and no scoliosis of =>20 (0% vs 6.8%, p = 0.058) after thoracoscopy. The coincidence of rib fusion and scoliosis was significant (9.1%, p = 0.022) for the open approach. In the thoracotomy group, multi-staged surgery and more frequent reoperations due to major complications were significantly associated with an increased occurrence of deformities. None of the patients after thoracoscopic multi-stage or complicated EA/TEF repair developed scoliosis. The frequency and severity of thoracic musculoskeletal deformities were significantly lower after the thoracoscopic approach. Thoracoscopy may be a more advantageous and preferred surgical approach for the EA/TEF treatment, although further randomized, controlled studies are necessary. Post-thoracotomy scoliosis may progress to a severity requiring surgery.

中文翻译：

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食管闭锁手术治疗后的胸部肌肉骨骼畸形 - 胸腔镜与开放手术：回顾性两中心队列研究

胸部肌肉骨骼畸形是食管闭锁（EA）开放矫正术长期随访期间的严重并发症。我们的目的是比较开放和胸腔镜 EA 修复术后胸部肌肉骨骼畸形的频率和严重程度。我们假设采用侵入性较小的胸腔镜手术后，畸形发生的可能性会更少。这项回顾性研究分析了 2005 年至 2021 年间在波兰两个小儿外科接受治疗的患者。患者组在手术方式、手术技术、多阶段手术适应症和术后并发症方面存在差异。该研究涵盖所有类型的 EA/TEF。第一组包括 68 名接受胸腔镜食管闭锁修复术（弗罗茨瓦夫）的患者，第二组包括 44 名接受开放修复术（华沙）的患者。对临床数据进行回顾性审查，结果认为 p < 0.05 具有显着性。胸腔镜组检查时的中位年龄为 6 岁，开胸手术组检查时的中位年龄为 5.5 岁。在胸腔镜组中，68 名患者中有 53 名 (77.9%) 接受了一期治疗，而在开胸手术组中，44 名患者中有 35 名 (79.5%) 接受了一期治疗。胸腔镜组胸椎肌肉骨骼畸形的发生率（1.5%）显着低于开胸手术组（34.1%，p < 0.001）。开胸术后脊柱侧弯的发生率明显更高（13.6% vs 1.5%，p = 0.016）。胸腔镜检查后，没有肋骨融合（0% vs 37.1%，p < 0.001），也没有脊柱侧凸 =>20（0% vs 6.8%，p = 0.058）。对于开放入路，肋骨融合和脊柱侧弯的一致性显着（9.1%，p = 0.022）。在开胸手术组中，多阶段手术和由于主要并发症导致的更频繁的再次手术与畸形发生率的增加显着相关。胸腔镜多阶段或复杂的 EA/TEF 修复术后患者均未出现脊柱侧凸。胸腔镜入路后，胸部肌肉骨骼畸形的频率和严重程度显着降低。尽管需要进一步的随机对照研究，胸腔镜检查可能是 EA/TEF 治疗更有利且首选的手术方法。开胸术后脊柱侧凸可能会发展到需要手术的严重程度。