Pulmonary Function After Thoracoscopic Esophageal Atresia Repair: Reduced Lung Volumes Despite Preserved Airflow in Childhood and Adolescence

Respiratory morbidity and pulmonary function impairment (PFI) are common after esophageal atresia (EA) repair. However, pulmonary function has not been extensively evaluated in large cohorts following thoracoscopic EA repair. This study assesses respiratory outcomes and pulmonary function during childhood and adolescence in this population and compares outcomes with studies on open EA repair. Patients who underwent thoracoscopic EA repair between 2006 and 2018 and received pulmonary function testing at follow-up were included. Respiratory outcome was noted. Assessments were conducted at ages 5, 8, 11, and 14 years and compared with the 2021 and 2022 Global Lung Function Initiative (GLI) reference equations. Eighty-two patients were included; 45 received antibiotics for respiratory tract infections after the first year. Median Z-scores for forced expiratory volume in 1 second divided by forced vital capacity (FEV1/FVC) were 0.05, 0.83, −0.21, and −1.27 at ages 5, 8, 11, and 14 years, with obstructive PFI in 8.2%, 10.0%, 10.8%, and 15.0%. Median Z-scores for total lung capacity (TLC) were 0.34, −0.59, and −0.66 with restrictive PFI in 0.0%, 13.8%, and 5.9% at ages 8, 11, and 14 years. Respiratory morbidity was common. Compared with the GLI reference population, patients after thoracoscopic EA repair showed similar obstructive PFI but lower lung volumes at older ages. Compared with study cohorts of open repair, thoracoscopic EA repair appears to result in less obstructive and restrictive impairment. Standardized, age-based pulmonary follow-up using GLI-based testing is recommended to monitor declining lung volumes over time, and long-term respiratory outcomes in patients with EA.