Thoracoscopic staged repair for type A and type B esophageal atresia: outcomes from a tertiary center

Purpose To evaluate outcomes of thoracoscopic staged internal traction combined with a waiting period in long-gap esophageal atresia (LGEA) at a single center. Methods Retrospective analysis of perinatal characteristics, surgical interventions, postoperative complications, and long-term outcomes in LGEA patients undergoing delayed thoracoscopic staged repair between 2018 and 2024. Results Among141 esophageal atresia repairs, 15 patients had LGEA (13 Gross type A, 2 type B). All patients underwent gastrostomy placement. The first thoracoscopic stage occurred at a median age 2.4 months (1.1–3.7). Internal traction was applied in 13/15 (86%), two required gastric interposition (GI) for an extreme long gap diagnosed at initial thoracoscopy. Traction patients underwent a median of 2 tractions (1–3). Delayed anastomosis was achieved in 10/13 (77%) within a median 11.5 days (6–43) from first thoracoscopy. In three, anastomosis remained unfeasible after traction due to a persistent long gap, necessitating GI. Complications included one recurrent fistula, one leak, and five strictures requiring a median 1.5 dilatations (1–7). At a median 50-month follow-up (12–91), all delayed-anastomosis patients and 60% of GI patients tolerated full oral feeds. Conclusion A delayed thoracoscopic staged internal traction enabled safe anastomosis with a low complication rate; however, one-third of patients required GI.