Thoracoscopic Salvage Surgery for Oesophageal Atresia is Feasible After Previous Thoracotomy

To describe the collective experience of six international tertiary paediatric surgery centres performing thoracoscopic salvage surgery for oesophageal atresia.

Retrospective review of all neonates undergoing thoracoscopic repair of oesophageal atresia following a previous failed repair via thoracotomy, from September 2018-May 2024, at 6 international tertiary paediatric surgery centres. Data collected included demographics, co-morbidities, operative details and post-operative clinical course. Results are presented as median with range.

24 babies were included. Median gestational age was 34 weeks (26-40), birthweight was 1858g (780-3300). 19 were Gross type C (79 %), 4 type B (17 %), with 1 type A (4 %). 7/24 (29 %) had thoracoscopic traction sutures, and 2/24 (8 %) had a cervical oesophagostomy formed prior to thoracoscopic repair. Definitive thoracoscopic repair was undertaken at 23 weeks (7-116) after initial thoracotomy, at 6 months of age (1-26) and weight of 5340g (1050-1100). Operative time was 245 min (120-585). 23/24 (96 %) were completed thoracoscopically. Follow-up was 36 months (7-130). 17/24 (71 %) developed an oesophageal stricture requiring a median of 5 dilatations (1-45). 2/24 (8 %) developed a fistula to the airway. 2/24 (8 %) developed significant gastro-oesophageal reflux disease requiring a fundoplication. One patient required an aortopexy and re-do aortopexy for management of tracheomalacia. There was 1 death at 11 months of age (2 months post definitive repair) in a patient with complex congenital cardiac disease. 22/23 (96 %) patients are feeding exclusively orally.

thoracoscopic salvage surgery in oesophageal atresia when undertaken by experienced surgeons is feasible, safe and with good clinical outcomes.