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Thoracic skeletal anomalies following surgical treatment of esophageal atresia. Lessons from a national cohort

François Bastard Arnaud Bonnard Véronique Rousseau Thomas Gelas Laurent Michaud 1 Sabine Irtan 2 Christian Piolat 3 Aline Ranke-Chrétien François Becmeur 4 Anne Dariel Thierry Lamireau 5, 6 Thierry Petit 7 Virginie Fouquet 8 Aurélie Le Mandat Francis Lefebvre Hassan Allal Joséphine Borgnon Julia Boubnova 9 Edouard Habonimana 10 Nicoleta Panait Philippe Buisson Marc Margaryan Jean-Luc Michel 11 Jean Gaudin Hubert Lardy 12 Frédéric Auber 13 Corinne Borderon 14 Philine de Vries 15 Olivier Jaby Laurent Fourcade 16 Jean-Francois Lecompte Cécilia Tolg Benoit Delorme Françoise Schmitt 17 Guillaume Podevin 18
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.

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https://hal.univ-angers.fr/hal-02648804
Contributeur : Okina Université d'Angers <>
Soumis le : vendredi 29 mai 2020 - 10:29:15
Dernière modification le : mercredi 14 octobre 2020 - 04:16:56

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François Bastard, Arnaud Bonnard, Véronique Rousseau, Thomas Gelas, Laurent Michaud, et al.. Thoracic skeletal anomalies following surgical treatment of esophageal atresia. Lessons from a national cohort. Journal of Pediatric Surgery, 2018, 53 (4), pp.605-609. ⟨10.1016/j.jpedsurg.2017.07.013⟩. ⟨hal-02648804⟩

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