Challenges of Long-Gap Esophageal Atresia Repair in a Patient With Tetralogy of Fallot and Right Aortic Arch

In cases of complex vascular anomalies or rare variants of esophageal atresia (EA), such as long-gap variant, individualized surgical planning becomes even more critical. We present a case report of a patient with long-gap EA, tetralogy of fallot (ToF), and right aortic arch (RAA), in which an initial right thoracotomy was unsuccessful due to unexpected vascular anatomy. Subsequent computed tomography (CT) imaging revealed the precise vascular configuration, prompting a change to a left thoracoscopic approach and staged repair using internal traction followed by early anastomosis. This case underscores the importance of preoperative vascular assessment and highlights the need for flexible surgical strategies in complex EA cases.