Is there an Increased Risk of Thoracoscopic Esophageal Leaks due to Intra-Pleural Pressures in Neonates - Abstract
Trans-pleural thoracoscopic repair of esophageal atresia was first performed in 1999. Esophageal leak rates are twice higher when compared to the open approach. Two-dimensional view and difficulty in suturing within the small neonatal chest cavity as well as the loss of tactile sensation may explain this higher leak rate. We propose that a sustained negative pleural pressure by trans-pleural approach may contribute to this leak rate. Over a 3-year period, 11 neonates undergoing patent ductus arteriosus ligation via extra- or trans-pleural approach were selected. After ligation, an intercostal drain was placed and a non-invasive manometer was connected to it. Continuous pressure measurement was carried out for 24 hours. In cases with extra-pleural approach; an initial negative pressure rapidly reached zero whereas in trans-pleural cases, pressures remained negative over 24 hours. It is therefore possible that increased esophageal leak may be as the result of sustained negative trans-pleural pressures.