Is Immediate Surgery Necessary? Research Supports Delayed Approach for Type C Esophageal Atresia
China: A recent study published in BMC Surgery explored whether thoracoscopic repair of type C esophageal atresia requires emergency intervention, providing valuable insights into surgical timing and outcomes. The findings suggest that advancements in neonatal surveillance enable appropriately delayed surgery without increasing respiratory infection risk, allowing surgeons to refine treatment plans.
The researchers note that thoracoscopic repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is performed more frequently. While many children undergo surgery within the first three days of life, the ideal timing for the procedure remains uncertain. Therefore, Shao-tao Tang, Huazhong University of Science and Technology, Wuhan, China, and colleagues aimed to evaluate the appropriate timing for thoracoscopic repair of type C EA and assess its mid-term clinical outcomes.
For this purpose, the researchers retrospectively analyzed 142 patients with esophageal atresia (EA) treated between 2009 and 2023. Among them, 109 patients with type C EA who underwent thoracoscopic one-stage repair were included. Based on surgical timing, patients were categorized into two groups: the early repair group (< 5 days) and the delayed repair group (≥ 5 days). Propensity score matching (PSM) was applied to minimize imbalances caused by severe cardiac complications, gestational age, and birth weight, ensuring a more accurate comparison between the two groups.
The study led to the following findings:
- The median age at surgery was 5 days, ranging from 1 to 16 days.
- After matching, 43 out of 59 patients in the early repair group (Group A) and 43 out of 50 patients in the delayed repair group (Group B) were included in the validation cohort.
- All 86 cases successfully underwent thoracoscopic one-stage repair surgery.
- Delayed surgery did not increase the incidence of preoperative or postoperative respiratory tract infections.
- Intraoperative and postoperative complications were similar between the two groups.
- Patients in Group B required fewer balloon dilations for anastomotic stricture during follow-up (1.8 ± 0.8 versus 3.1 ± 1.1).
The study showed that in patients with type C esophageal atresia, delayed thoracoscopic repair is a safe and viable option, with postoperative outcomes comparable to early repair. Performing the surgery at or after five days in a well-equipped NICU does not increase the risk of preoperative respiratory infections compared to earlier interventions.
"These findings support a more flexible surgical approach, allowing better allocation of operating room resources by postponing emergency repairs to scheduled surgical days without compromising patient outcomes," the researchers concluded.
Reference:
Wang, C., Cao, G., Li, K. et al. Does thoracoscopic repair of type C esophageal atresia require emergency treatment? BMC Surg 25, 66 (2025). https://doi.org/10.1186/s12893-025-02798-9
