Abstract
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.