702 - Comparative Outcomes of Thoracoscopic, Open, and Combined Approaches for Type C Tracheoesophageal Fistula Repair: A Single-Center Retrospective Study

Publication Number: 1679.702

Sheryar Siddiqui, CHOC Children's Hospital of Orange County, Orange, CA, United States; Maryam Gholizadeh, CHOC Children's Hospital of Orange County, Orange, CA, United States; Adnan Ismail, CHOC Children's Hospital of Orange County, Irvine, CA, United States; yigit Guner, UC Irvine, Irvine, CA, United States; Hira Ahmad, Rady Children's Health, Orange, CA, United States; Mustafa Kabeer, CHOC Children's Hospital of Orange County, Orange, CA, United States; Irfan Ahmad, CHOC Children's Hospital of Orange County, Orange, CA, United States

Background: Tracheoesophageal fistula (TEF) is a common neonatal congenital anomaly requiring surgical repair. The traditional open thoracotomy approach, though allowing direct visualization and control of the anastomosis, is associated with significant postoperative pain and longer recovery. Thoracoscopic repair has emerged as a minimally-invasive option, but its adoption has been limited by concerns for complications such as anastomotic leak and stricture. A combined approach to thorascopically ligate the fistula and mobilize the esophagus followed by an open thoracotomy for the anastomosis is occasionally used. Despite increasing use of minimally-invasive techniques, comparative data across these three approaches remain limited.

Objective: Compare postoperative outcomes of thoracoscopic, open, and combined thoracoscopic-open approaches for repair of Type C TEF.

Design/Methods: This retrospective cohort study included infants undergoing surgical repair of type C TEF at a tertiary center between 2012 and 2025. Cases were identified from the Surgical NICU database and categorized by operative approach: thoracoscopic, open, or combined. Demographic data and postoperative data were collected. Statistical analysis involved the Kruskall-Wallis test and Chi-square testing. The primary outcomes were postoperative complications, including anastomotic leak, stricture, need for dilation, vocal cord paralysis, and diaphragmatic hemiparesis. Secondary outcomes included time to feed initiation and full feeds, length of stay (LOS), and respiratory morbidity.

Results: A total of 95 infants met inclusion criteria (15% thoracoscopic, 75% open, and 10% combined). Median length of stay and time to extubation differed significantly, with combined and thoracoscopic repairs associated with longer recovery times (Table 1). The need for gastrostomy tube (G-tube) placement and diaphragmatic hemiparesis were significantly higher after thoracoscopic repair (p < .05). Rates of anastomotic leak, stricture, and vocal cord paralysis were higher after thoracoscopic repair, though not statistically significant. Data collection and multivariable analyses are ongoing to further evaluate the significance of these findings.

Conclusion(s): This 13-year single-center study confirms higher risk associated with thoracoscopic repair of type C TEF. This includes longer ventilator needs, LOS, and increased risk of diaphragmatic hemiparesis, and G-tube placement following thoracoscopic repair. These risks should be considered when determining the mode of surgical repair of TEF patients.

Table 1 - Demographics and Outcomes of Different Surgical Approaches for Type C TEF Repair
A p-value of <.05 was considered statistically significant.
* denotes statistical significance