A Comparative Analysis of Thoracoscopic Surgery versus Thoracotomy for the Treatment of Type III Esophageal Atresia

Objective To explore the short-to-medium-term efficacy of thoracoscopic and open surgical approaches in the treatment of Type III esophageal atresia in neonates, compare the feasibility of the two surgical methods, and provide references for clinical practice. Methods A retrospective study was conducted to analyze the clinical data of 170 patients diagnosed with type III esophageal atresia who were admitted to the Affiliated Hospital of Zunyi Medical University during the period from January 2011 to December 2024. Among these patients, 101 were male and 69 were female. According to the surgical modality adopted, the patients were stratified into the open surgery group (n=78) and the thoracoscopic group (n=92). The thoracoscopic group was further categorized into three subgroups based on birth weight: the low birth weight group (<2000 g), the sub-low birth weight group (2000–2499 g), and the normal birth weight group (≥2500 g). Multiple perioperative observational indicators and the incidence of postoperative complications were compared across groups. The cumulative sum (CUSUM) analysis was employed to assess the learning curve associated with intracorporeal manipulation. Results No statistically significant differences were observed in the baseline characteristics between the open surgery group and the thoracoscopic group (all P > 0.05). Compared with the open surgery group, the thoracoscopic group exhibited a significantly shorter operation time [115.5 (108, 129) min vs. 126 (118, 152) min, P < 0.001], less intraoperative blood loss [2 (1, 3) mL vs. 5 (5, 7) mL, P < 0.001], and a shorter surgical incision [1 (1, 1.3) cm vs. 7 (6.5, 7) cm, P < 0.001]. Additionally, the thoracoscopic group showed significantly reduced duration of postoperative mechanical ventilation [94 (56.3, 116.7) h vs. 106 (66.5, 145.5) h, P < 0.001] and shorter postoperative hospital stay [22 (18, 26) d vs. 25 (22, 28) d, P < 0.001] compared with the open surgery group, with statistically significant differences (both P < 0.001). The incidence of postoperative anastomotic leakage was comparable between the two groups (20.6% vs. 28.2%, P = 0.333). A total of 47 low birth weight infants underwent thoracoscopic surgery. No statistically significant differences were found in the duration of postoperative mechanical ventilation, postoperative hospital stay, postoperative hospitalization costs, incidence of postoperative anastomotic leakage, or incidence of esophageal stricture between the low birth weight group and the normal birth weight group (all P > 0.05). However, the low birth weight group had a longer operation time compared with the normal birth weight group [129.0 (117.0, 140.8) min vs. 114.0 (106.0, 126.8) min, P < 0.05], and the intraoperative blood loss differed significantly among the three subgroups of the thoracoscopic group [low birth weight group: 2.5 (2.0, 3.0) mL; sub-low birth weight group: 2.5 (2.0, 4.2) mL; normal birth weight group: 1.0 (1.0, 1.5) mL, P < 0.05]. The learning curve analysis demonstrated that the thoracoscopic group entered a stable and efficient technical plateau earlier. Conclusions Compared with open surgery, thoracoscopic surgery for type III congenital esophageal atresia (CEA) offers advantages including safety, minimal invasiveness, a broad surgical field of view, more precise manipulation, and accelerated postoperative recovery. It is a safe and effective surgical approach that is suitable for clinical popularization.