Clinical outcomes in TEF patients treated by thoracoscopic repair: a multicenter study from the East Asia Pediatric Surgery Research Consortium [Oral presentation]

Abstract

<div><p><strong>Purpose:</strong> Despite its introduction nearly 25 years ago, thoracoscopic repair for tracheoesophageal fistula (TEF) has not been widely adopted. We reviewed the clinical outcomes of thoracoscopic TEF repair performed at 5 leading East Asian pediatric minimally invasive surgery centers.</p><p><strong>Methods</strong>: A retrospective review was conducted of patients with TEF (gross type C) who underwent primary thoracoscopic repair between 2008 and 2024. Patients with gross type A, long-gap TEF requiring staged repair, or trisomy 18 were excluded. Collected data included demographics, operative results, complications, and long-term outcomes.</p><p><strong>Results: </strong>In total, 124 patients underwent thoracoscopic TEF repair during the study period. The median gestational age, birth weight, and age at surgery were 38 weeks (37–39), 2560 g (2210–2836), and 2 days after birth (1–3), respectively. The diagnosis was confirmed prenatally in 21 patients (16.9%). Twenty-nine patients (23.4%) had cardiac anomalies, 8 (6.5%) had chromosomal anomalies (excluding trisomy 18), and 66 (53.2%) had other associated anomalies. The median operative time and intraoperative blood loss were 180 min (137–222 min) and 1 ml (0–5 mL), respectively. Five patients (4.0%) required open conversion, 9 (7.3%) required blood transfusion, 9 experienced intraoperative organ injury (7.3%), and 23 underwent simultaneous procedures (18.5%). The median length of hospital stay was 48.5 days (28.0–85.3). During hospitalization, anastomotic leakage occurred in 8 (6.5%) patients, pneumothorax occurred in 13 (10.5%), chylothorax occurred in 8 (6.5%), and atelectasis occurred in 4 (3.2%). The long-term outcomes included anastomotic stenosis requiring dilatation in 46 patients (37.0%), recurrence of TEF in 4 (0.8%), and gastroesophageal reflux in 48 (38.7%). The long-term mortality rate was 2.4%.</p><p><strong>Conclusion: </strong>The results of this study indicate low rates of open conversion, morbidity, and mortality in patients who were carefully selected and treated at highly skilled institutions.</p></div>