A multicentre audit of the use of bronchoscopy during open and thoracoscopic repair of oesophageal atresia with tracheo‐oesophageal fistula

Summary

Background

Oesophageal atresia with tracheo‐oesophageal fistula is usually repaired in the neonatal period. Preferential ventilation through the fistula can lead to gastric distension. Bronchoscopy has a role in defining the site and size of the fistula and may be carried out by the surgeon or the anaesthetist. The use of bronchoscopy varies across different institutions.

Methods

This is a multi‐centre case note review of infants with oesophageal atresia with tracheo‐oesophageal fistula who underwent surgery between January 2010 and December 2015. This retrospective audit aims primarily to document the use of bronchoscopy during open and thoracoscopic repair at a selection of United Kingdom centres. We also note details of respiratory complications, i.e. relating to airway management, the respiratory system and difficulty with ventilation; at induction and during surgery. The range of techniques for anaesthesia and analgesia in these centres is noted.

Results

Bronchoscopy was carried out in 52% of cases. The incidence of respiratory complications was 7% at induction and 21% during surgery. Thoracoscopic repair usually took longer. One centre used High Frequency Oscillatory Ventilation, on an elective basis during thoracoscopic repair, to facilitate surgical access and address concerns about hypoxemia and hypercarbia.

Conclusion

Use of bronchoscopy varies considerably between institutions. Infants undergoing tracheo‐oesophageal fistula repair are at risk of peri‐operative respiratory morbidity. The advent of thoracoscopic repair has introduced further variation.

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