BACKGROUND: Thoracoscopic repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) has been performed with increasing frequency. Although many children have underwent surgery within three days after birth, the optimal timing for operation remains undetermined. This study aimed to investigate the appropriate timing for thoracoscopic repair of type C EA and its mid-term clinical outcomes. METHOD: We retrospectively analyzed 142 patients with EA between April 2009 and April 2023. A total of 109 patients with type C EA who underwent thoracoscopic one-stage repair surgery were included. The patients were divided into two groups based on surgical timing: the early repair group (<
5 days) and the delayed repair group (≥ 5 days). Patients in the two groups were matched using propensity score matching (PSM) to eliminate the imbalance between groups caused by confounding factors such as severe cardiac complications, gestational age, and birth weight. RESULT: The median age at surgery was 5 days (range: 1-16 days). After matching, 43 patients (out of 59) in the early repair group (group A) and 43 patients (out of 50) in the delayed repair group (group B) were included in the validation cohort. All cases (n = 86) successfully completed thoracoscopic one-stage repair surgery. Delayed surgery did not increase the incidence of preoperative and postoperative respiratory tract infections. Intraoperative and postoperative complications were comparable between the two groups. Intraoperative and postoperative complications were comparable between the two groups
however, patients in group B experienced a lower frequency of balloon dilation (1.8 ± 0.8 vs. 3.1 ± 1.1, P = 0.035) for anastomotic stricture during follow-up. CONCLUSIONS: With improvements in neonatal surveillance, appropriately delayed surgery does not increase the incidence of respiratory infections, allowing surgeons to optimize treatment plans.