Thoracoscopic management of recurrent tracheoesophageal fistula: a single-center outcome analysis

Although thoracoscopic treatment of congenital esophageal atresia is widely accepted among pediatric surgeons, its application in recurrent tracheoesophageal fistula (RTEF) remains rare because of its technical difficulty. This study retrospectively analyzed thoracoscopic RTEF repairs at a single center to evaluate the safety, feasibility, and outcomes of this approach, providing a clinical reference. We retrospectively reviewed 22 patients with RTEF who underwent thoracoscopic repair at the Capital Center for Children's Health between October 2020 and July 2024. All patients had a history of type III esophageal atresia repair, including 13 cases of type IIIa and 9 cases of type IIIb (Gross classification). The cohort included 8 male and 14 female patients, with an admission age of 2 to 30 months (mean: 8.0 ± 7.2) and weight of 2.3 to 11.0 kg (mean: 5.5 ± 2.4). There were 16 first recurrences, 5 s recurrences, and 1 fourth recurrence. Five patients had failed previous endoscopic fistula ligation, and 9 had a history of open thoracotomy. All 22 underwent thoracoscopic repair. Thoracoscopic RTEF repair was successfully completed in all 22 patients (100%). The operation time ranged from 136 to 420 min (mean: 288.5 ± 93.1), hospitalization ranged from 15 to 124 days (median: 24), and postoperative invasive ventilator support lasted 0 to 480 h (median: 20). Esophageal leakage occurred in 6 patients (27.3%), all of whom recovered with 1 to 8 weeks of conservative treatment. Esophageal stenosis developed in 8 patients (36.4%), including 6 pre-existing and 2 new-onset cases; all improved after 1 to 6 sessions of endoscopic balloon dilation. During follow-up (0.5–4 years), only 1 patient (4.5%) experienced re-recurrence; the remaining patients showed good growth and development. Thoracoscopic treatment of RTEF following esophageal atresia is safe, feasible, and yields satisfactory clinical outcomes.