Clinical outcomes of primary thoracoscopic repair in patients with esophageal atresia and tracheoesophageal fistula: A multicenter study from the East Asia pediatric surgery research consortium

Abstract

<p><b>Purpose:</b> Thoracoscopic repair for esophageal atresia/tracheoesophageal fistula (EA/TEF) has not been widely adopted despite its introduction nearly 25 years ago. We reviewed the clinical outcomes of primary thoracoscopic EA/TEF repair performed at 5 leading centers for minimally invasive pediatric surgery in East Asia. <br></p><p><b>Methods:</b> A retrospective review was conducted of patients with EA/TEF (Gross type C) who underwent primary thoracoscopic repair between 2008 and 2024. Patients with Gross type A/B/D/E, long-gap EA requiring staged repair, or trisomy18 were excluded. Collected data included demographics, surgical outcomes, and long-term outcomes. <br></p><p><b>Results: </b>A total of 127 patients underwent thoracoscopic repair for EA/TEF during the study period. The mean gestational age, birth weight, and age at surgery were 38 ± 2.1 weeks, 2540 ± 487 g, and 3.0 ± 7.5 days, respectively. Thirty patients (23.6 %) had cardiac anomalies, and 8 (6.3 %) had chromosomal anomalies (excluding trisomy18). The mean operative time and intraoperative blood loss were 191 ± 67 min and 4.3 ± 8.7 mL, respectively. Nine patients (7.1 %) required conversion to open surgery and 10 (7.9 %) required blood transfusions. The mean length of hospitalization was 74 ± 73 days. Postoperative complications included anastomotic leak in 8 (6.3 %) patients and chylothorax in 9 (7.1 %). The long-term outcomes included anastomotic stenosis requiring dilatation in 52 patients (41.6 %), gastroesophageal reflux (GER) in 49 patients (39.2 %), and recurrent TEF in 3 (2.4 %). Mortality case was recognized in 2 (1.6 %). <br></p><p><b>Conclusion:</b> The results of this study indicate that thoracoscopic repair for EA/TEF is a safe procedure when performed on selected patients and in centers with suitable thoracoscopic experience.</p>