Thoracoscopic Repair of Esophageal Atresia with Distal Tracheoesophageal Fistula: Is It Safe to Delay Surgery?

Abstract

Aim of the study: Thoracoscopic repair of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is an increasingly adopted approach. However, it is a complex minimally invasive technique that should be performed by experienced surgeons under optimal conditions. This study aims to determine whether delaying surgery to ensure these conditions is safe.

Methods: We conducted a retrospective observational study (2017 to 2024) analyzing historical cohorts of 41 neonates with EA and distal TEF who underwent thoracoscopic repair. Fifteen (36.5%) were operated on the first day of life (Group A), while 26 (63.5%) underwent delayed surgery (Group B). Baseline characteristics, preoperative and intraoperative morbidity and mortality, and follow-up outcomes were analyzed.

Results: There were no significant differences in sex, gestational age, birth weight, or associated anomalies, including anorectal malformation. Group B neonates underwent surgery at 2.38 ± 0.76 days of life. No preoperative respiratory infections or need for emergency surgery were reported, and there were no significant differences in atelectasis (6.6% versus 11%), respiratory distress (40% versus 34%), or intubation requirement (13% versus 19%). Intraoperatively, conversion rates (6.6% versus 7.6%) and desaturation events (20% versus 19%) were comparable. Postoperatively, no differences were found in intubation days (3.3 versus 3.37), infections (6.6% versus 11.5%), atelectasis (13.3% versus 19.2%), or follow-up complications (P > .05).

Conclusions: Delaying the repair of EA with distal TEF is safe, allowing thoracoscopic surgery to be performed by experienced surgeons under optimal conditions without increasing morbidity due to the wait.