Thoracoscopic internal traction for long-gap esophageal atresia: outcomes, challenges, and complications.

Aim: To evaluate our institutional experience with thoracoscopic staged repair with internal traction (TSRIT) in the management of long-gap esophageal atresia (LGEA), focusing on surgical techniques, early and late outcomes, and functional results.

Method: Between 2019 and 2024, EA patients who underwent TSIRT in LGEA were retrospectively reviewed. Demographics, surgical details, and early and late complications were collected. Early-late complications were compared between groups. Causes of traction failure and complications were examined. Swallowing function was assessed using the Pediatric EAT-10 score.

Results: Thirteen patients (Type A/B:5/8) underwent TSIRT. Traction failed in three cases (Type A/B:1/2), and these patients were referred to replacement surgery. Definitive anastomosis was successfully achieved in 10 of 13 patients. In 3 cases, traction failed due to technical or anatomical factors. Early complications included 4 anastomotic leaks (A/B:3/1) and 2 strictures(A/B:0/2); all were managed conservatively. Late complications included mild anastomotic strictures in 5 patients(A/B:1/4) and gastroesophageal reflux in 3(A/B:0/3), none of whom required fundoplication. All patients demonstrated adequate growth during follow-up, and most achieved satisfactory oral intake. The medium follow-up time was similar between the groups, with a mean follow-up duration of 30 months.

Conclusion: In the long-term follow-up, the majority of patients demonstrated good oral intake. The failure rate was 23%. While no statistically significant difference was observed between the groups regarding early and late complications, the higher incidence of complications in the Type B group suggests that these patients require closer monitoring and more meticulous management.