Thoracoscopic approaches in the management of long gap esophageal atresia: Analysis of the French cohort

AIM: Long-gap esophageal atresia (LGEA) represents a surgical challenge. Despite the increasing use of thoracoscopy over the past decades, its application in LGEAs remains limited. This study aimed to evaluate the morbidity and mortality rates of LGEA thoracoscopic repair in the early and mid-term in France over the study period. MATERIALS AND METHODS: After institutional ethical approval (#23.76), we conducted a multicenter, retrospective analysis of all patients who underwent a thoracoscopic repair for LGEA in France from 2010 to 2022. LGEA was defined following ERNICA 2021 consensus. We collected data related to the initial treatment and up to 1-year follow-up. Postoperative complications were categorized into early (30 days) and were classified according to the Clavien-Dindo classification. RESULTS: Fifty patients were included: 24 Delayed Primary Anastomosis (DPA) and 26 tractions. The overall rate of post-operative complication was 82%. The primary early complications included anastomotic leaks 56%, prolonged drainage 40%, pneumothorax 20%, pneumonia 20% and stricture 16% with no difference between DPA and traction. The traction method had a longer postoperative length of stay (69 vs. 31 days, p < 0,002). The nutritional evolution of tractions was poorer, with 30,8% exclusive oral nutrition at one year (vs. 66,7% DPA, p = 0.018). CONCLUSION: This is the largest cohort of patients who underwent thoracoscopic surgery for LGEA. Although thoracoscopic management of LGEAs is associated with a high complication rate, DPA management was associated with a shorter postoperative hospital stay and better mid-term nutritional outcomes. We believe that LGEAs remain a surgical challenge and thoracoscopy should be reserved for expert surgeons.