INoEA 2025 7th International Conference on Esophageal Atresia & 11th International PAAFIS Symposium & Aerodigestive Society Meeting

L Magni, T Teunissen, D Focke, J Verweij, E Reuling, D van der Zee, M Lindeboom, S Tytgat

Department of Pediatric Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht

Purpose

The classification and management of long-gap esophageal atresia (LGEA) vary in literature, particularly when the distal esophagus is short and involves a carinal fistula. We hypothesize similar feasibility of early primary anastomosis in type C esophageal atresia with carinal fistula (TEFC) versus cases with a distal tracheoesophageal fistula located higher on the tracheal wall (TEFT) when using a novel thoracoscopic mobilization and intraoperative internal traction approach in TEFC patients.

Method
We retrospectively reviewed 134 patients (25 TEFC, 109 TEFT) treated thoracoscopically at our center between 2012-2024. Primary outcomes analyzed were native esophagus preservation and anastomotic leakage rates. Secondary outcomes included short- and long-term clinical results up to 12 years and growth patterns from 6 months to 5 years.

Results
All patients underwent successful repair within the first two weeks after birth without requiring esophageal replacement. In the TEFC cohort, 23 patients achieved single-surgery anastomosis using intraoperative traction, while two required external traction and a second surgery for anastomosis one week later. Although TEFC patients experienced higher anastomotic leakage rates (40% vs. 20.2%), median postoperative hospital stay was comparable (23 vs. 20 days). During outpatient follow-up, TEFC patients had higher rates of recurrent stenosis (24% vs. 10.1%) and indication for anti-reflux surgery (26.1% vs. 11.3%). However, revision surgery rates for recurrent fistula (0% vs. 11.5%) and stenosis (0% vs. 1.8%) were lower in TEFC patients. Long-term growth outcomes showed no significant differences between groups.

Conclusion

Treatment of TEFC patients was more complex than that of TEFT patients, with higher postoperative complication rates. However, the native esophagus was preserved in all 25 patients without major revision surgeries, facilitated by thoracoscopic mobilization and intraoperative traction techniques. These findings highlight the short- and long-term benefits of managing TEFC patients in specialized centers with expertise in thoracoscopic treatment of LGEA.

L Magni, T Teunissen, D Focke, J Verweij, E Reuling, D van der Zee, M Lindeboom, S Tytgat

Department of Pediatric Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht

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