Thoracoscopic management of esophageal duplication cysts in children: technical considerations and perioperative strategies from a two-case series.

Mediastinal esophageal duplication cysts are rare congenital foregut malformations that may cause respiratory symptoms due to airway compression. Excision is recommended once a diagnosis is made to prevent infection, bleeding, or rupture. We report two boys with recurrent wheeze/stridor or chronic cough; contrast-enhanced chest computed tomography showed paraesophageal cysts (20-30 mm) in the right posterior mediastinum. Both underwent thoracoscopic resection using a three-port approach with low-pressure CO₂ insufflation. Operative time was ~120 min with minimal blood loss (~10 mL). One infant had a small esophageal mucosal injury that was repaired intraoperatively; oral feeding resumed after a negative contrast study on postoperative day 5. The other patient resumed oral intake on postoperative day 1. They were discharged within 7 days and remained recurrence-free at 12 months. Thoracoscopic excision is feasible, safe, and cosmetically favorable in children. We highlight critical technical considerations in preventing, managing esophageal mucosal injury, and optimizing postoperative feeding.