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Objective <p>To evaluate the safety and efficacy of the “spaghetti” dissection technique in thoracoscopic repair of congenital type C esophageal atresia (EA).</p> Methods <p>A total of 58 neonates with confirmed type C EA who underwent thoracoscopic surgery at Huai’an Maternity and Child Health Hospital from March 2019 to June 2025 were consecutively enrolled. Patients were randomly assigned to two groups: (1) Group A (n = 30): Thoracoscopic “spaghetti” dissection technique was used for proximal esophageal dissection followed by end-to-end esophageal anastomosis; (2) Group B (n = 28): Traditional thoracoscopic proximal esophageal dissection with an electrocautery hook was performed, followed by anastomosis. Descriptive statistics were used to report the safety and operative outcomes of the “spaghetti” technique, including proximal esophageal dissection time, total operative time, intraoperative tracheal injury, postoperative complications and clinical recovery indicators.</p> Results <p>Descriptive analysis showed that the proximal esophageal dissection time in Group A was 18.9 ± 2.7&#xa0;min, and the total operative time was 111.5 ± 12.4&#xa0;min. No tracheal injury occurred in Group A. Postoperative ventilator support time, time to first oral feeding, and hospital stay in Group A were 2.1 ± 0.7&#xa0;days, 7.8 ± 1.4&#xa0;days, and 16.0 ± 1.6&#xa0;days, respectively. Upper gastrointestinal contrast radiography 5–7&#xa0;days postoperatively showed minor anastomotic leakages in 3 cases (10%) and postoperative anastomotic stenosis in 5 cases (16.6%) in Group A. No recurrence of tracheoesophageal fistula (TEF) was observed in Group A during follow-up. For Group B (internal control), the corresponding indicators were briefly described for reference: proximal esophageal dissection time 28.4 ± 5.1&#xa0;min, total operative time 146.1 ± 28.4&#xa0;min, tracheal injury in 2 cases (7.1%), minor anastomotic leakages in 4 cases (14.2%), and anastomotic stenosis in 4 cases (14.2%). No recurrence of TEF was also observed in Group B during the follow-up period.</p> Conclusion <p>The “spaghetti” technique’s core benefit is its atraumatic winding fixation, which evenly distributes traction to mitigate esophageal mucosal injury. It also facilitates tracheoesophageal space dissection via stable exposure of the surgical field, enhancing surgical maneuverability. Reduction in operative time constitutes a clinically valuable advantage.</p>

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Application of “spaghetti” dissection technique in thoracoscopic repair of congenital type C esophageal atresia- a prospective case series study

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Shichun Zhu,
  • Zhenyong Liu,
  • Bing Li

摘要

Objective

To evaluate the safety and efficacy of the “spaghetti” dissection technique in thoracoscopic repair of congenital type C esophageal atresia (EA).

Methods

A total of 58 neonates with confirmed type C EA who underwent thoracoscopic surgery at Huai’an Maternity and Child Health Hospital from March 2019 to June 2025 were consecutively enrolled. Patients were randomly assigned to two groups: (1) Group A (n = 30): Thoracoscopic “spaghetti” dissection technique was used for proximal esophageal dissection followed by end-to-end esophageal anastomosis; (2) Group B (n = 28): Traditional thoracoscopic proximal esophageal dissection with an electrocautery hook was performed, followed by anastomosis. Descriptive statistics were used to report the safety and operative outcomes of the “spaghetti” technique, including proximal esophageal dissection time, total operative time, intraoperative tracheal injury, postoperative complications and clinical recovery indicators.

Results

Descriptive analysis showed that the proximal esophageal dissection time in Group A was 18.9 ± 2.7 min, and the total operative time was 111.5 ± 12.4 min. No tracheal injury occurred in Group A. Postoperative ventilator support time, time to first oral feeding, and hospital stay in Group A were 2.1 ± 0.7 days, 7.8 ± 1.4 days, and 16.0 ± 1.6 days, respectively. Upper gastrointestinal contrast radiography 5–7 days postoperatively showed minor anastomotic leakages in 3 cases (10%) and postoperative anastomotic stenosis in 5 cases (16.6%) in Group A. No recurrence of tracheoesophageal fistula (TEF) was observed in Group A during follow-up. For Group B (internal control), the corresponding indicators were briefly described for reference: proximal esophageal dissection time 28.4 ± 5.1 min, total operative time 146.1 ± 28.4 min, tracheal injury in 2 cases (7.1%), minor anastomotic leakages in 4 cases (14.2%), and anastomotic stenosis in 4 cases (14.2%). No recurrence of TEF was also observed in Group B during the follow-up period.

Conclusion

The “spaghetti” technique’s core benefit is its atraumatic winding fixation, which evenly distributes traction to mitigate esophageal mucosal injury. It also facilitates tracheoesophageal space dissection via stable exposure of the surgical field, enhancing surgical maneuverability. Reduction in operative time constitutes a clinically valuable advantage.