Thoracoscopic repair (TR) versus conventional open repair (COR) for esophageal atresia–tracheoesophageal fistula (TEF–EA): a pilot randomized controlled trial

Tracheoesophageal fistula with or without esophageal atresia (TEF–EA), a common thoracic congenital malformation, is traditionally corrected via open approach; however, minimally invasive thoracoscopic repair is fast gaining traction. There is paucity of evidence regarding superior or comparative surgical outcomes among the two techniques, emphasizing the need for a prospective, randomized trial.

Sixteen neonates with TEF–EA were randomized equally into two intervention groups (Conventional Open Repair and Thoracoscopic Repair) after excluding patients with birth weight < 2 kg, associated anomalies, severe cardiorespiratory compromise, and prior attempted surgical repair. Both the groups were compared with respect to baseline characteristics, and various intraoperative and postoperative outcomes.

Both the groups were comparable with regards to age at surgery, intraoperative blood loss and injuries, median duration of sedo-analgesia, inotropic support, and mechanical ventilation. The primary outcome, i.e., the combined incidence of anastomotic leak and stricture during 6-month follow-up period postoperatively, was not significantly different between the groups (p = 0.315). The median operating time and intraoperative end-tidal carbon dioxide was significantly higher in the thoracoscopic group (p < 0.001). Full oral feeds could be established significantly earlier in the thoracoscopic group (p = 0.048), and they also had a significantly shorter duration of hospital stay (p = 0.029).

Thoracoscopic repair (TR) of TEF is a safe, effective, minimal invasive surgical technique. The outcomes in terms of postoperative leak and early stricture rates were comparable between the groups. In addition to the already well-established advantages of minimal access approach, early discharge and early feeding are added benefits. As medical education continues to evolve, integrating inanimate models into the curriculum can empower surgeons to navigate the steep learning curve, ensuring the delivery of safe and effective patient care in the era of minimally invasive surgery.