The trachea, a missed organ in esophageal atresia complex: Evolution of a thoracoscopic approach

Purpose: We report our experience with a thoracoscopic repair of esophageal atresia, pitfalls made and how avoiding them yielded a better outcome for our patients. Methods Prospective cohort study was conducted to thoracoscopically repaired type-C EA patients between November 2016 and November 2022. Group A included patients, who were managed during the initial phase of our study and presented with different respiratory symptoms. Group B, that included patients who had their repair done later in the study period after refining our surgical techniques to overcome the earlier fallacies. Results In group A, 26 patients had successful repair, 15 patients developed respiratory-related symptoms due to esophageal causes (3/15) and tracheal causes (12/15). Tracheomalacia (11/15), tracheal diverticulum (10/15) and recurrent tracheoesophageal fistula (rTEF) (3/15) were detected in that group. In group B, which included 57 patients, significant reduction in the number of symptomatizing patients was noticed, from 58 to 30%. Seventeen patients developed symptoms, secondary to esophageal origin (12/17), rTEF (4/17) and tracheomalacia in addition to the rTEF in one patient. Conclusions Tracheal abnormalities with EA need more attention. Not only is bronchoscopy an informative initial step before attempting repair, but it may also reveal the possible need for primary tracheopexy.