The popularity of operating by the extrapleural approach is more than the transpleural approach because there is a belief between pediatric surgeons that there is increased incidence of empyema following leakage in the transpleural approach, we had no cases of empyema in our study neither in the tanspleural or the extrapleural group but we noticed that the patient with leakage in the extrapleural group responded will to conservative treatment within few weeks (2 ,3).
The incidence of pneumothorax in our study was 15%, which occurred in 25% of transpleural group and was right-sided (related to the operative procedure) and occurred in 8.3% of the extrapleural group and was left-sided (related to high pressure postoperative ventilation). All cases responded to intercostal tube insertion; in another similar study, the incidence of pneumothorax was 20% with all cases occurred in transpleural group .
The incidence of leakage of anastomosis in the textbooks of pediatric surgery ranged from 14 to 16%, and in other studies, it was 10–20%. In our study, leakage occurred in 2 (10%) cases, in which one case improved on conservative treatment (operated by extrapleural approach), while the other case in transpleural group did not respond to conservative treatment. Redo surgery was done (esophagostomy and gastrostomy), but there was no statistical difference between the two groups as regards the incidence of leakage [4,5,6,7].
In the literature, mortality rate depends on the type of atresia, prematurity, aspiration pneumonia, and severe cardiac anomaly. In this study, we excluded premature neonates, neonates weighing less than 2000 g and patients with cyanotic heart anomaly; moreover, some authors concluded that anesthesia and postoperative intensive care may also have a role in survival of the patients, and we had a mortality rate 10% with no statistical difference between the two groups .
In our study, duration of surgery was significantly shorter in patients operated by transpleural technique due to the time needed for gentle detachment of the pleura from the chest wall in extrapleural approach, but actually, we need a larger study to evaluate the superiority of extrapleural approach in promoting spontaneous closure if leakage occurs.