Thoracoscopic Stage Internal Traction Repair Reduces Time to Achieve Esophageal Continuity in Long Gap Esophageal Atresia

Abstract

Aim of the study: Management of long gap oesophageal atresia (LGOA) is controversial. This study aims at comparing the management of LGOA between two high-volume centers. Methods: We included patients with LGOA (type A and B) between 2008 and 2022. Demographics, surgical methods and outcomes were collected and compared. Results: The study population involved 28 patients–Centre A and 24 patients–Centre B. A surgical approach was thoracoscopic in the Centre A, only for one patient was open for final procedure. In the Centre B 3 patients were treated only thoracoscopically, 2 converted to open and 19 as open surgery. In the Centre A primary oesophageal anastomosis concerned 1 case, two-staged oesophageal lengthening using external traction-1 patient and 26 were treated with the multi-staged internal traction technique. In 24 patients a full anastomosis was achieved: in 23 patients the internal traction technique solely was used, and 1 patient required open Collis-Nissen procedure as final management. In the Centre B primary anastomosis was performed in 7 patients, delayed oesophageal anastomosis in 8 patients, oesophageal lengthening using external traction in one case and 9 infants required oesophageal replacement with gastric tube. Analysed postoperative complications included: early mortality-2/28 due to accompanied malformations (Centre A) and 0/24 (Centre B); anastomotic leakage-4/26 (Centre A) treated conservatively-all patients had a contrast study and 0/24 (Centre B)-1 case of pleural effusion, but no routine contrast study); recurrent strictures 13/26 (Centre A) and 7/15 (Centre B); need for fundoplication 5/26 (Centre A) and 2/15(Centre B). Age at oesophageal continuity was as a median 31 days in Centre A and 110 days in Centre B. Median time between initial procedure and the oesophageal anastomosis was 11 days in Centre A and 92 days in Centre B Conclusions: Thoracoscopic internal traction technique reduces time to achieve oesophageal continuity and the need for oesophageal substitution while maintaining a similar early complication rate.