WOFAPS 2025 8th World Congress of Pediatric Surgery

Natalia Newland ¹, Jiri Snajdauf ¹, Alena Kokesova ¹, Jitka Styblova ¹, Stepan Coufal ², Michal Rygl ¹

¹ Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
² Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the Czech Academy of Sciences

Purpose:
Thoracoscopic staged internal traction repair offers the possibility of preserving the native esophagus in patients with long-gap esophageal atresia (LGEA). This study evaluates the outcomes of this approach in a single tertiary center.

Methods:
A retrospective analysis of perinatal characteristics, surgical interventions, postoperative complications and long-term outcomes was conducted in patients with LGEA who underwent thoracoscopic repair between 2018 and 2024.

Results:
Of 141 patients operated for esophageal atresia (EA) in the seven-year period, 15 patients had LGEA (13 Gross type A, 2 Gross type B). Of those, prenatal suspicion for EA was documented in 85% (11/13) of followed pregnancies. Eight patients (53%) had associated anomalies. All LGEA patients underwent gastrostomy insertion after birth. The first thoracoscopic stage was performed at a mean age of 2.5 months. Internal traction was applied in 13 patients (87%). The remaining two required gastric interposition due to an extreme long gap identified at initial thoracoscopy. Internal traction patients underwent a mean of 1.8 tractions (range 1–3). Delayed anastomosis was achieved in 77% (10/13) within a mean of 15 days. The remaining three underwent gastric interposition due to persistent long gap. Complications included one recurrent fistula, one anastomotic leak and five anastomotic strictures requiring a mean of 2.0 dilatations (range 1–7). All patients with delayed anastomosis and 60% of gastric interposition patients were tolerating full oral feeds at a mean follow-up of 49 months (range 7.5 – 91).

Conclusion:
Of patients undergoing internal traction, 77% achieved successful delayed anastomosis within 15 days on average and with a mean of 1.8 trations. The most common complication was anastomotic stricture, affecting 50% of patients. All patients with delayed anastomosis achieved full oral feeds. Gastric interposition was required in one-third of all patients.