Thoracoscopic salvage surgery for oesophageal atresia is feasible after previous thoracotomy

Aim: To describe the collective experience of six international tertiary paediatric surgery centres performing thoracoscopic salvage surgery for oesophageal atresia. Methods: Retrospective review of all neonates undergoing thoracoscopic repair of oesophageal atresia following a previous failed repair via thoracotomy, from September 2018–May 2024, at 6 international tertiary paediatric surgery centres. Data collected included demographics, co-morbidities, operative details and post-operative clinical course. Results are presented as median with range. Results: 24 babies were included. Median gestational age was 34 weeks (26–40), birthweight was 1858g (780–3300). 19 were Gross type C (79 %), 4 type B (17 %), with 1 type A (4 %). 7/24 (29 %) had thoracoscopic traction sutures, and 2/24 (8 %) had a cervical oesophagostomy formed prior to thoracoscopic repair. Definitive thoracoscopic repair was undertaken at 23 weeks (7–116) after initial thoracotomy, at 6 months of age (1–26) and weight of 5340g (1050–1100). Operative time was 245 min (120–585). 23/24 (96 %) were completed thoracoscopically. Follow-up was 36 months (7–130). 17/24 (71 %) developed an oesophageal stricture requiring a median of 5 dilatations (1–45). 2/24 (8 %) developed a fistula to the airway. 2/24 (8 %) developed significant gastro-oesophageal reflux disease requiring a fundoplication. One patient required an aortopexy and re-do aortopexy for management of tracheomalacia. There was 1 death at 11 months of age (2 months post definitive repair) in a patient with complex congenital cardiac disease. 22/23 (96 %) patients are feeding exclusively orally. Conclusion: thoracoscopic salvage surgery in oesophageal atresia when undertaken by experienced surgeons is feasible, safe and with good clinical outcomes.