Modified thoracoscopic anastomosis of esophageal atresia with tracheoesophageal fistula.

OBJECTIVE: This study aims to evaluate the modified thoracoscopic esophageal anastomotic methods in cases with esophageal atresia with tracheoesophageal fistula (EA-TEF). METHODS: From January 2019 to August 2024, a total of 12 consecutive infants with type 3 EA-TEF underwent modified thoracoscopic esophageal anastomosis in our department. The modified methods (Group A) included: (1) posterior wall anastomosis performed using two mattress sutures with 5 − 0 PDS; (2) subsequently, the anterior wall anastomosis was completed with continuous locked stitches using 5 − 0 PDS. The outcomes were compared with those of the conventional group (Group B, n = 15), who underwent traditional esophageal anastomosis with interrupted sutures during the same period. RESULTS: In Group A, the operative time was 123.7 ± 12.0 min (range, 105–135 min), while in Group B, the operative time was 145.7 ± 13.5 min (range, 135–185 min). A significant difference was observed in operative time between the two groups (P < 0.001). The duration of the esophageal anastomosis is 36.0 ± 3.9 min (range 22–45) in group A, 44.4 ± 4.1 min (range, 38–52) in group B (P<0.001). In Group A, two patients experienced small leaks; similarly, three patients in Group B demonstrated small leaks, there was no significant difference between the two groups (P>0.05). Five cases formatted stricture needed dilation in group A, and four cases in group B (P>0.05). CONCLUSION: The modified method is an effective and safe technique in EA-TEF capable of minimizing the operative time without increasing morbidity and mortality.