Successful one-stage thoracoscopic repair of esophageal atresia with tracheoesophageal fistula and associated foregut duplication cyst in a neonate: a case report and review of the literature

BACKGROUND: Esophageal atresia with tracheoesophageal fistula (EA-TEF) complicated by foregut duplication (FD) cyst is an exceedingly rare congenital anomaly. Since the first description in 1956, only 20 cases have been reported, with open thoracotomy representing the standard surgical approach. We present a case of successful one-stage thoracoscopic repair of this complex association in a neonate. CASE PRESENTATION: A male neonate weighing 2080 g was diagnosed with Gross type C EA-TEF. At 3 days of age, right thoracoscopic exploration identified a 1-cm FD cyst on the distal esophageal wall. Complete cyst enucleation with mucosal preservation and muscle layer reconstruction was performed, followed by fistula ligation and primary esophageal anastomosis. Histopathology confirmed FD cyst with stratified squamous, columnar, and simple flat epithelium. The postoperative course was complicated by pneumonia, suspected anastomotic leak, and anastomotic stricture requiring three dilations. At 10-month follow-up, the infant demonstrated catch-up growth (weight 8 kg, 10th percentile; height 72 cm, 25th percentile) with no recurrence of fistula or cyst. CONCLUSIONS: One-stage thoracoscopic repair of EA-TEF with concurrent FD cyst enucleation appears technically feasible in selected neonates. The magnified visualization afforded by thoracoscopy may, in some cases, facilitate intraoperative identification of FD. However, this approach does not eliminate anastomotic complications inherent to EA surgery. Patient selection, surgical expertise, and long-term functional outcomes require further investigation.