Long-Term Musculoskeletal Implications of Neonatal Thoracotomy: Is Thoracoscopy Worth the Hype?

Thoracotomy versus thoracoscopy for esophageal atresia is often debated in literature. Many series claim higher long-term musculoskeletal complications with thoracotomy. Morbidity factors generated out of the chest opening in the short and long terms are numerous. Scoliosis, winging of the scapula, and chest asymmetry are long-term morbidities. The incidence of musculoskeletal complications after thoracotomy is approximately 20–50% and varies over a wide range in different series. These series include not just esophageal atresia but other neonatal conditions as well requiring thoracotomy. With improving techniques of thoracotomy, these musculoskeletal complications have been minimized, especially with muscle-sparing and nerve-preserving incisions. This chapter outlines the possible musculoskeletal complications and examines the evidence in the literature about the long-term complications of neonatal thoracotomy and how much edge it provides in the short and long terms for neonates of esophageal atresia compared to thoracoscopy.