Outcomes After Thoracoscopic and Open Repair of Esophageal Atresia With Tracheoesophageal Fistula at US Children's Hospitals.

BACKGROUND

Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) has been reported to have superior outcomes to the open approach. We sought to evaluate adoption of thoracoscopic repair at US children's hospitals and compare outcomes to open repair.

METHODS

The Pediatric Health Information System database was used to identify patients with EA/TEF who underwent repair between 2016 and 2023. Patients with birthweight less than 1800g and/or repair after the first 3 days of life were excluded. Postoperative complications, length of stay, and opioid requirements were assessed.

RESULTS

Inclusion criteria were met in 618 patients. Eighty thoracoscopic repairs were reported (13 %). The proportion of thoracoscopic operations did not change over the study period. Infants managed with a thoracoscopic or open approach were demographically similar. Thoracoscopic repair was associated with a higher incidence of anastomotic stricture (39 % vs. 26 %, p = 0.02), recurrent laryngeal nerve (RLN) injury (11 % vs 3 %, p = 0.001), and fewer days of postoperative opioid (5.2 vs. 6.5, p = 0.04). Other operative complications, LOS, and duration of TPN did not differ based on operative approach.

CONCLUSION

A small proportion of EA/TEF repairs in US children's hospitals were completed thoracoscopically and adoption of this approach did not increase between 2016 and 2023. Anastomotic stricture and RLN injury were significantly more likely after thoracoscopic repair. Although opioids were administered for one day fewer after thoracoscopic operations, no other metrics favored this approach. These data contrast with recent literature and suggest that the experience of high-volume hospitals may underestimate the morbidity of thoracoscopic EA/TEF repair and overestimate its benefits.