Esophageal atresia surgery in the 21st century.

The results of thoracoscopic repair of oesophageal atresia with or without tracheo-oesophageal fistula are presented. Twenty-six children had the repair performed thoracoscopically (22 in Edinburgh and 4 by Edinburgh surgeons in other institutions). Twenty infants had oesophageal atresia with tracheo-oesophageal fistula and 6 had isolated oesophageal atresia without fistula. Details of the technique are presented. Birth weights ranged from 1.4 to 3.9 kg and children were operated between 1 day and three months of age. There were 7 minor anastomotic leaks all managed conservatively, 1 recurrent fistula managed thoracoscopically and 9 anastomotic strictures. One child had a tracheo-bronchial fistula not seen at original thoracoscopy. There were 3 deaths (one child with Edward's syndrome, one with associated congenital diaphragmatic hernia and one late death with severe cardiac disease). Thoracoscopic repair of oesophageal atresia is feasible and the long term outcome appears favorable.