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

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.

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.

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.

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.