The role of delayed thoracoscopic internal traction in type A esophageal atresia, single center’s experience

Background:In long gap esophageal atresia (EA), staged repair is often recommended when the surgeon isunable to perform primary anastomosis. Due to the lack of adequate parenteral nutrition, highincidence of sepsis and complications associated with invasive ventilation in neonates indeveloping countries, delayed procedures are preferred over those during neonatal life.Patients and Methods: This is a case series of patients with type-A EA presented to our institute during the period 2019-2025. Initially feeding gastrostomy tubes were inserted. Later thoracoscopic tractions were planned after ensuring adequate anabolic status and good chest condition. Delayed thoracoscopic internal traction was performed using absorbable sutures that were reinforced using 5mm clips. During the later procedure, the surgeon assessed whether further traction was needed or anastomosis could be performed with minimal tension.Results:During the study period, 6 patients presented with type A EA. The mean age at thoracoscopic traction was 5.1 months (range; 1-14 months). Four patients had successful anastomosis after two sessions of traction in 2 patients while one session for the other two. After anastomosis, two patients developed an anastomotic leak that healed successfully. Three patients developed anastomotic strictures that are being dilated endoscopically.Conclusion:In low-to-middle- income countries, deferring traction and anastomosis are recommended until the patient achieves adequate anabolic and physiological state to tolerate multiple surgical procedures.