Tracheoesophageal fistula in the developing world: are we ready for thoracoscopic repair?
Journal – Pediatric Surgery International
Publication date – Mar – 2020
Authors – Hossam S. Alslaim, Andrew B. Banooni, Ahmad Shaltaf & Nathan M. Novotny
Keywords – Global health; Minimally invasive surgery; Neonatal anesthesia; Neonatal surgery; Thoracoscopy
Open access – Yes
Speciality – Cardiothoracic surgery, Paediatric surgery
World region Global
Language – English
Submitted to the One Surgery Index on May 29, 2020 at 1:06 pm
Purpose: Tracheoesophageal fistula (TEF) is a bellwether for a country’s ability to care for sick newborns. We aim to review the existing literature from low- and middle-income countries in regard to management of those newborns and the possible approaches to improve their outcomes.
Methods: A review of the existing English literature was conducted with the aim of assessing challenges faced by providers in LMIC in terms of diagnostic, preoperative, operative and post-operative care for TEF patients. We also review the limited literature for performing thoracoscopic repair in the developing world context and suggest methods for introduction of advanced thoracoscopic procedures including techniques for providing anesthesia to these challenging babies.
Results: While outcomes related to technique from LMIC are comparable to the developed world, rates of secondary complications like sepsis and pneumonia are higher. In many areas, repairs are conducted in a staged fashion with minimal utilization of thoracoscopic approach. The paucity of resources creates strain on intraoperative and post-operative management.
Conclusion: Clearly, not all developing world contexts are ready to attempt thoracoscopic repair but we outline suggestions for assessing the existing capabilities and a stepwise gradual implementation of advanced thoracoscopy when appropriate.
OSI Number – 20447
PMID – 32219560