**6. Complications**

312 Front Lines of Thoracic Surgery

The *gestational age and the birth weight* of MAS patients were not different from open repairs in the comparative studies (2.7-2.8 kg MAS vs 2.0-2.4 open Table 1). In the minimal invasive group the thoracoscopic approach was succesfully performed even in premature babies with weights below 1500 g 18,5,2 but these are not different from data in the literature for open

Concerning the *associated malformations and risk classification* only Holcomb 11 et al present data on Waterston classification(A 62, B 30 and C12) respectively. The reported associated malformations were seen in up to 87.5% 9 of the thoracoscopically repaired babies, but in the comparative studies no difference is seen between MAS (39-87%) and open (47-72%)

Mean *duration of operation* was recorded in 12 articles and ranged between 95 and 260 minutes. In the comparative studies the paper of Szavay 10 reveals a significantly longer operation time (open 106 min versus MAS 141). But Al Tokhais 4 and Lugo 9 did not find a significant difference in operation time between them with 179 and 123 min open and 149

*The conversion rate* was reported in 15 papers, in which no conversion was done in 9 papers

The *duration of postoperative ventilation* was mentioned in 10 papers. One reported no difference between open and MAS patients 4, others reported mean duration of 4 days post-

and in the remaining 6 papers the rates varied between 5 and 16%.

Table 3.

**4. Patiens' characteristics** 

repair (19 , mean 2557 with range 1100-4460 g).

concerning these associated malformations

**5. Perioperative data** 

and 156 min.for MAS.

The main short term complications are leakage of the anastomosis, anastomotic strictures and recurrent TEF. (Table 1, 2, 3)

*Anastomotic leakage* was reported in 18 papers. Important is that the definition may differ between the papers depending on whether routine esophagograms were performed or not. Most leaks were described as minor and healed spontaneously. The incidence varies between 0 and 30% with a median 15%. There is no difference with the reported leak rates in the open thoracotomies in the papers 8,9,23,24,22 and in the literature.(Table 3)

A clear definition of *anastomotic stricture* is an important factor. Most authors define stricture by the need for (repeated) dilatations however others state that narrowing of more than 50% of the lumen or every narrowing detected on an esophagram with a symptomatic patient can be seen as an anastomic stricture 25,26. Sixteen papers reported an incidence between 9 and 45%, with a median of 22%. This incidence is comparable to the rates reported after open repair (6-52%) by Holland 24 and in the literature (Table 3).

The incidence of the serious complication of a *recurrent tracheo-oesophageal fistula* was noted in 8 articles. The incidence varied between 0 (in 5 papers) and 4%. In the open repair series and in the literature, similar incidences have been reported (Table 3).
