Letter to the Editor in Response to: Short- and Long-Term Outcomes of Thoracoscopic and Open Repair for Esophageal Atresia and Tracheoesophageal Fistula

Abstract

We have read with interest the study of Yalcin, et al., titled “Short- and Long-Term Outcomes of Thoracoscopic and Open Repair For Esophageal Atresia and Tracheoesophageal Fistula”, in which they published their esophageal atresia experiences [1]. The article by Yalcin et al. provides a comprehensive analysis of the short- and long-term outcomes of thoracoscopic versus open repair in patients with esophageal atresia and tracheoesophageal fistula (EA/TEF). This retrospective cohort study, encompassing two decades of data, offers valuable insights into the efficacy and safety of these surgical techniques. The authors' data cover the years 2000-2020. Although recent meta-analyses have not shown significant results regarding anastomotic stricture and anastomotic leak, they recommend preserving the azygos vein to reduce the risk of pneumonitis. I would like to ask the authors whether they have preserved the azygos vein in cases since 2020? It appears from the study that, up until 2020, the azygos vein was transected in all patients. Although the authors have discussed long-term outcomes, the study does not report on “musculoskeletal anomalies after EA repair,” a topic that has recently gained significant attention. Studies by Aubert et al. [2], Borselle et al. [3], and Hattori et al. [4] have reported lower rates of scoliosis in the thoracoscopic (TR) group. Similarly, these studies found significantly lower rates of rib deformity in the TR group. Our unpublished meta-analysis revealed that the TR group had a significantly lower scoliosis rate compared to the conventional open repair (COR) group (I2 ¼ 36%) (RR: 0.35, 95% CI: 0.14 to 0.84; p ¼ 0.02). The overall scoliosis rates in the TR and COR groups were 3.1% and 16%, respectively (Fig. 1). Additionally, our unpublished meta-analysis found that the TR group had significantly lower rib deformity rates compared to the COR group (I2 ¼ 0%) (RR: 0.05, 95% CI: 0.01 to 0.25; p ¼ 0.0002). The overall rib deformity rates were 0% in the TR group and 41.5% in the COR group (Fig. 2). I would like to ask Yalcin et al. whether they have evaluated long-term musculoskeletal complications, such as scoliosis and rib deformity, which are quite common after thoracotomy. If they have, publishing their data would provide valuable evidence and contribute to a more rigorous meta-analysis on this subject.