Staged Thoracoscopic Repair of Long-Gap Esophageal Atresia Without Temporary Gastrostomy.

Introduction: Primary repair of long-gap esophageal atresia (LGEA) continues to present a surgical challenge. The number of treatment options, including the use of native esophagus or esophageal replacement, shows the difficulty in the treatment and lack of one superior option. Until recently all children with LGEA required temporary gastrostomy before esophageal reconstruction. Objective: The aim of the study is to present new therapeutic management in patients with LGEA, involving staged thoracoscopic procedure with internal traction without gastrostomy. Materials and Methods: Four neonates with LGEA were treated in two academic Departments of Pediatric Surgery in Poland from 2015 to 2018. The intervention was staged thoracoscopic approach, consisting in internal traction, followed by delayed esophageal anastomosis in neonatal period. The outcome measures were successful anastomosis, short time anastomosis complications, and timing of gastric/oral feeding. Results: Internal traction was placed between 2 and 6 days of life. A successful repair of native esophagus by the second approach in neonatal period without gastrostomy was achieved in 3 out of 4 neonates, 5-8 days after internal traction placement. No anastomotic leakage was observed, two anastomoses developed stricture managed with three and four sessions of repeated dilatation. Nasogastric tube feeding started between 5 and 7 days with full oral feeding achieved between 10 and 35 days after anastomosis. Follow-up was after 1-34 months. Conclusions: Our technique should be considered an alternative first-line strategy for the repair of LGEA without the use of a gastrostomy.