Trends and outcomes of thoracoscopic esophageal atresia and tracheoesophageal fistula repair: a retrospective analysis 2016–2022

Purpose: Thoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) is a technically demanding operation. We hypothesize thoracoscopic repair of EA with TEF over time has increased, with improved or equivalent outcomes compared to open. Methods: NSQIP-P identified patients < 30 days with EA and TEF who underwent repair of both defects from 2016 to 2022. Patients were categorized into (1) intention to treat (thoracoscopic/thoracoscopic converted to open); and (2) thoracoscopic only, both compared to open only patients. Coarsened exact matching was performed. Pre/post-match analysis utilized X², Fisher’s exact, and Mann-Whitney-U tests. Results: Overall, 1,188 patients were identified with 147 (12.4%) thoracoscopic only, 129 (10.8%) converted to open, and 912 (76.8%) open only. Thoracoscopic repair increased (2016–2022) for intention to treat (12.0% vs. 29.4%, p = 0.001) and thoracoscopic only (7.2% vs. 19.1%, p = 0.012) cohorts. Matched analysis identified thoracoscopic patients had reduced length of stay (p = 0.005) and longer operative time (< 0.01); however, no difference in other outcomes were identified (p > 0.05). Conclusion: Thoracoscopic repair of EA with TEF attempts have increased to roughly 30%, and it is associated with reduced length of stay and longer operative times without other outcome differences. This analysis affirms the short-term safety of thoracoscopic repair of EA and TEF. Level of evidence (I-V): Level III.