OBJECTIVE

The purpose of this systematic review is to analyze the results of the use of thoracoscopy in children with H-type congenital tracheoesophageal fistula.

MATERIAL AND METHODS

As part of this study, a search was made for articles In Russian and English published in the Elibrary, MEDLINE, PubMed databases. The following search terms were used: «thoracoscopy», «H-type tracheoesophageal fistula», «isolated tracheoesophageal fistula», «type E tracheoesophageal fistula» according to R. Gross classification. Based on these criteria, 175 scientific articles were found, published in English (172 articles) and Russian (3 articles) languages. Inclusion criteria were articles reporting research on the diagnosis and treatment of congenital tracheoesophageal fistula in the absence of esophageal atresia. Articles were excluded after careful review of the title and abstract if the studies contained evidence of acquired or recurrent tracheoesophageal fistula.

RESULTS

Of the 175 articles found in the initial search, only 9 articles were considered eligible for this systematic review, totaling 42 patients who underwent thoracoscopic fistula division. The largest study in terms of the number of patients included 12 patients, the smallest — 1 patient. The mean age of the patients included in this review was 25.2 weeks. Gender ratio (boys: girls) — 26:16. Most of the H-type fistulas were located at the level of Th_I-Th_IV, which provides optimal thoracoscopic access. One study reported that thoracoscopy was used when the fistula was located at the C_VII level. The most popular technique was complete division of the fistula (32 patients). Simple ligation of the fistula without its division was performed in 8 patients. Another 2 patients used an endoscopic stapler with a diameter of 5 mm. The total number of complications was 11. Anastomotic failure was recorded in 3 patients. Paresis of the vocal cords as a result of damage to the recurrent nerves was recorded in 3 cases. The most common complication was gastroesophageal reflux. It accompanied the postoperative course of the disease in 7 patients.

CONCLUSION

This systematic review found that thoracoscopy can be used in children with H-type tracheoesophageal fistula. The effectiveness of the minimally invasive technique was confirmed by the low level of postoperative complications that do not pose a threat to the life of the child.