Delayed Thoracoscopic Repair Following Abdominal Esophageal Banding in a 539-g Infant With Triple Atresia: A Case Report.

Triple atresia, comprising esophageal atresia, duodenal atresia, and anorectal malformation, has no established management strategy in extremely low-birth-weight (ELBW) infants. We report successful staged treatment in a 539-g infant with severe respiratory failure. Transabdominal esophageal banding and gastrostomy on Day 0 controlled airflow through the tracheoesophageal fistula without thoracic intervention. Duodeno-duodenostomy and transverse colostomy were performed on Day 18 (680 g), permitting enteral feeding. After growth to 1924 g, thoracoscopic repair of Gross type C esophageal atresia was completed on Day 127. The temporary band was removed without esophageal injury. The patient was discharged on Day 219 at 2793 g with partial oral intake and no anastomotic stricture. This abdominal-first strategy served as a bridge from cardiorespiratory stabilization and enteral nutrition to delayed thoracoscopic repair while preserving an unoperated thoracic cavity.