O2145: Outcomes After Thoracoscopic and Open Repair of Esophageal Atresia with Tracheoesophageal Fistula at US Children’s Hospitals

Background: The first thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) was reported in 1999. Multiple single center and consortium studies as well as a meta-analysis have demonstrated equivalent morbidity and shorter length of stay (LOS) with thoracoscopic repair compared to the traditional open approach. We sought to evaluate the extent of adoption of thoracoscopic repair at US children’s hospitals and to compare outcomes between patients who underwent a thoracoscopic or open repair.

Methods: The Pediatric Health Information System (PHIS) database was used to identify patients with EA/TEF who underwent repair between 2016 and 2023. The operative approach was determined based on procedure codes. In order to exclude patients with major comorbidities that affected the choice of operation, only patients with birthweight greater than 1800 grams operated on within the first three days of life were included in the analysis. The proportion of EA/TEF repairs accomplished with a thoracoscopic approach was calculated for each PHIS hospital. The primary outcomes were stricture requiring dilation, anastomotic leak, and vocal cord paralysis. Secondary outcomes included LOS, duration of parenteral nutrition (TPN), days of narcotic administration, and mortality.

Results: Inclusion criteria were met in 543 patients and 65 (12%) underwent a thoracoscopic repair. The proportion of thoracoscopic operations did not change over the study period. At least one thoracoscopic repair was reported in 26 (57%) hospitals and none used a thoracoscopic approach in more than 50% of their cases (Figure). Infants managed with a thoracoscopic or open repair were demographically similar. The incidence of esophageal stricture requiring at least one dilation was significantly greater after thoracoscopic repair (36.9% vs. 24.7%, p=.035). Other operative complications, LOS, and duration of TPN and narcotics did not differ based on operative approach (Table).

Conclusion: In a large cohort of patients managed in US children’s hospitals, the adoption of thoracoscopic repair of EA/TEF did not increase between 2016 and 2023, with 43% of hospitals reporting no cases. An anastomotic stricture that required dilation was significantly more common after thoracoscopic repair. The incidence of other complications was similar. The duration of narcotic treatment and LOS were not different after thoracoscopic or open operations. These data contrast with recent literature, much of which is from centers with relatively high case volumes, that suggest shorter LOS and less pain after thoracoscopic repairs.