Biliary atresia (BA), a rare but life-threatening neonatal cholestatic disorder, necessitates Kasai portoenterostomy (KPE) as the primary surgical intervention. However, despite timely KPE within the recommended 60-day window, approximately 60

Recurrent tracheoesophageal fistula (RTEF) is one of the most challenging long-term complications following primary repair of esophageal atresia/tracheoesophageal fistula (EA/TEF). Thoracoscopic revision has been increasingly used in patients. Anastomotic leakage (AL) remains an important postoperative complication after RTEF repair. Objective predictors for surgical timing and AL risk are limited. We retrospectively analyzed patients undergoing thoracoscopic RTEF repair at Beijing Children’s Hospital between January 2019 and January 2025. Preoperative, intraoperative, and postoperative variables were evaluated to identify predictors of AL. Based on preoperative features, a transfer learning (TL) model was developed to predict AL risk. A total of 92 thoracoscopic repairs were performed in 84 patients, with AL occurring in 23/92 cases (25.0

Importance:Early diagnosis of biliary atresia (BA) is important for advancing the Kasai operation time and improving the BA prognosis. Objective:To develop machine learning (ML) models for neonatal BA diagnosis using clinical characteristics and serological data. Methods:Neonates presenting with pathological jaundice between January 1, 2013, and December 31, 2023 were enrolled. Five ML models-logistic regression (LR), random forest (RF), support vector machine classifier (SVC), multilayer perceptron (MLP), and extreme gradient boosting (XGBoost)-were trained using neonatal clinical and laboratory data. The stacking classifier (SC) algorithm was employed to select the best-performing models for constructing the ensemble learning model. Results:This study included 85 patients, 42 of whom were diagnosed with BA. Among the five ML models, XGBoost (area under the receiver operating characteristic curve [AUC] = 1.000; 95% confidence interval [CI]: 1.000-1.000) and the RF (AUC = 1.000; 95% CI: 1.000-1.000) demonstrated better diagnostic performance. All models showed acceptable consistency between the predicted and actual probabilities. The SC model, built on the LR, RF, and XGBoost models, also exhibited a strong generalization ability and diagnostic performance (AUC = 1.000; 95% CI: 1.000-1.000). Key diagnostic predictors included elevated gamma-glutamyl transpeptidase (GGT) (AUC = 0.837; 95% CI: 0.749-0.925), increased platelet (PLT) counts (AUC = 0.728; 95% CI: 0.618-0.838), and acholic stools (AUC = 0.765; 95% CI: 0.663-0.867). An XGBoost-based nomogram was also developed. Interpretation:ML models demonstrate high diagnostic accuracy for BA in neonates, with GGT, PLT counts, and acholic stools as pivotal predictors. This approach may enable earlier BA identification and intervention during the neonatal period.

This study aimed to evaluate discrepancies in prognosis after the Kasai portoenterostomy (KPE) procedure between neonatal and non-neonatal periods among patients undergoing the KPE procedure less than 60 days after birth (≤ 60 days). All type III BA patients who performed KPE less than 60 days from June 2020 to May 2024 in the Department of Neonatal Surgery of Beijing Children’s Hospital were retrospectively reviewed. They were divided into two groups according to the age at Kasai: the early KPE group (EK group, or neonatal group ≤ 30 days after birth) and the late KPE group (LK group, or non-neonatal group 31–60 days after birth), to evaluate the effect of surgical age on the postoperative efficacy following Kasai. 61 BA patients were included in our study. The median age at KPE in the EK group was 14.0 [10.0, 20.0] days and 47.0 [36.8, 51.1] days in the LK group. Regarding postoperative complications, Patients in the EK group tended to have a higher incidence of postoperative intestinal obstruction (10.5

BACKGROUND & AIMS:Biliary atresia (BA) is a severe neonatal cholangiopathy characterized by progressive inflammation and fibrosis. We aimed to systematically investigate the pathogenesis of BA using integrated multi-omics. METHODS:We performed multi-omics analysis of BA and control livers. CX3CR1+ CD8+ effector T (Teff) cells were isolated via flow cytometry and subjected to functional assays, including sphingosine-1-phosphate (S1P)-gradient Transwell migration, tissue-resident memory T (TRM) differentiation, and cholangiocyte co-culture apoptosis analysis. We then studied the effect of sphingosine-1-phosphate receptor 4 (S1PR4) inhibition in mice with rhesus rotavirus (RRV)-induced BA, validating our findings through histopathology, flow cytometry, and serum biochemistry. RESULTS:Multi-omics data showed that sphingolipid metabolism was pathologically activated in the S1 subtype of BA, a molecular subtype marked by abnormal immune inflammation and poor prognosis. Single-cell RNA profiling identified S1PR4 as primarily expressed in CX3CR1+ CD8+ Teff cells. In vitro, S1P/S1PR4 signaling promoted CX3CR1+ CD8+ Teff migration and facilitated their differentiation into CD8+ TRM cells. Co-culture of CD8+ TRM cells with cholangiocytes induced apoptosis. In vivo, S1PR4 inhibition alleviated liver inflammation and fibrosis by limiting CD8+ TRM accumulation. CONCLUSIONS:We identified an S1 subtype of BA characterized by dysregulated immune pathways and poor prognosis. S1P/S1PR4 signaling promotes cholangiocyte injury by driving CX3CR1+ CD8+ Teff migration and their differentiation into apoptosis-inducing CD8+ TRM cells. IMPACT AND IMPLICATIONS:Our study addresses a critical knowledge gap in biliary atresia (BA) pathogenesis by showing that sphingolipid-driven CD8+ TRM differentiation through S1P/S1PR4 signaling worsens bile duct injury, establishing a mechanistic link between immunometabolic dysregulation and BA progression. These findings are particularly relevant to pediatric hepatologists and immunologists, as they identify those with the S1 molecular subtype - characterized by poor prognosis and immune hyperactivation - as a high-risk population warranting precision intervention. In preclinical BA mouse models, S1PR4 inhibition (CYM50358) reduced biliary obstruction and improved survival, supporting its prioritization for clinical trials, especially in S1-subtype BA.

Background Biliary atresia (BA) is a severe liver disease in neonates, which is caused by obliteration of the intra- and the extrahepatic biliary duct leading to cholestasis, and progressive liver injury and fibrosis. Epithelial-mesenchymal transformation (EMT) of bile duct epithelial cells is considered to be a key mechanism in the pathogenesis of liver fibrosis. The present study aimed to explore the role and underlying mechanism of ferroptosis in EMT and liver fibrosis. Methods Thirty-four cases of BA liver tissue and twenty-two cases of adjacent normal liver tissue from hepatoblastoma were subjected to RNA-sequencing and proteomic analysis to verify the expression differences of EMT and fibrosis between BA and non-BA liver tissues, as well as the correlation between the expression level of the differential gene SFXN3 in BA and clinical pathological characteristics. A mouse liver model of biliary atresia induced by rotavirus in rhesus monkeys was constructed to verify the expression differences of EMT and fibrosis-related genes. A fibrosis model was constructed by inducing cholangiocytes with TGF-β, and the effects of SFXN3 knockdown and overexpression on cellular ferroptosis, EMT, and fibrosis were studied. Results We found that EMT-related molecules were significantly upregulated in BA patients. In addition, RT-PCR and Western blot experiments on liver of BA mice also revealed significant activation of fibrosis and EMT-related molecules In terms of mechanism, we found that SFXN3 was significantly upregulated in the fibrotic liver of patients (IDDF2024-ABS-0285 Figure 1). And it is positively correlated with the degree of fibrosis, EMT and clinical assay index. We discovered through colocalization that SFXN3 is localized to the biliary epithelial cells (IDDF2024-ABS-0285 Figure 2). Mechanically, we found that nuclear receptor coactivator NCOA4, a master regulator of ferritin phagocytosis, significantly activates and degrades ferritin during EMT, thereby releasing large amounts of ferrous, further leading to SFXN3-dependent mitochondrial iron overload. Conversely, knockdown of NCOA4 or SFXN3 with small interfering RNAs could effectively ameliorate ferroptotic cell death, cellular or mitochondrial iron overload and lipid peroxides accumulation (IDDF2024-ABS-0285 Figure 3). Conclusions Overall, our findings underscore that ferritinophagy activation and SFXN3-dependent mitochondrial iron overload play critical roles in ferroptosis and EMT in biliary atresia.

Recurrent tracheoesophageal fistula (rTEF) is a rare complication following initial esophageal atresia (EA) surgical repair, posing challenges in localization the fistula during surgery due to severe thoracic adhesions and structural ambiguity from previous operations. We introduced two new localization methods for rTEF patients during surgery and aimed to compare the impact of using these localization techniques versus not using them on the surgical outcomes for rTEF patients. We retrospectively analyzed the clinical data of rTEF cases that underwent thoracoscopic repair at our hospital from September 2017 to December 2024. Patients were divided into localization group and non-localization group based on whether using intraoperative localization techniques, and comparative analysis of clinical variables was conducted between groups. A total of 106 patients were included in this study, undergoing a total of 113 thoracoscopic rTEF repair surgeries at our center. Their fistula type included 89 cases of tracheoesophageal fistula (TEF), 19 cases of esophageal-pulmonary fistula (EPF), 3 cases of esophageal bronchial fistula (EBF), and 2 cases of combined EPF and TEF. All cases were categorized based on whether using localization techniques, resulting in the localization group (n = 52) and the non-localization group (n = 61). The median operation time in the localization group (2.5 h) was significantly lower than in the latter (3.0 h) (P = 0.001), and regardless of the fistula type being TEF or EPF. Additionally, the average postoperative hospital stay was significantly shorter in the localization group (17.7 ± 7.5 days) than in the non-localization group (23.6 ± 20.0 days) regarding the fistula type of TEF (P = 0.03). The use of localization techniques in thoracoscopic surgery for rTEF leads to better outcomes, evidenced by reduced operation time and hospital stay, suggesting enhanced surgical accuracy and improved patient postoperative recovery. LEVEL III.

OBJECTIVE:To develop a machine learning diagnostic model based on MMP7 and other serological testing indicators for early and efficient diagnosis of biliary atresia (BA). METHODS:A retrospective analysis was conducted on patient information from those hospitalized for pathological jaundice at Beijing Children's Hospital between January 1, 2019, and December 31, 2023. Patients with serum MMP7, liver stiffness measurements, and other routine serological tests were included in the study. Six machine learning models were constructed, including logistic regression (LR), random forest (RF), decision tree (DET), support vector machine classifier (SVC), neural network (MLP), and extreme gradient boosting (XGBoost), to diagnose BA. The area under the receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the various models. RESULTS:A total of 98 patients were included in the study, comprising 64 BA patients and 34 patients with other cholestatic liver diseases. Among the six machine learning models, the XGBoost algorithm model and RF algorithm model achieved the best predictive performance, with an AUROC of nearly 100% in both the training and validation sets. In the training set, these two algorithm models achieved an accuracy, precision, recall, F1 score, and AUROC of 1. Through model interpretation analysis, serum MMP7 levels, serum GGT levels, and acholic stools were identified as the most important indicators for diagnosing BA. The nomogram constructed based on the XGBoost algorithm model also demonstrated convenient and efficient diagnostic efficacy. CONCLUSION:Machine learning models, especially the XGBoost algorithm and RF algorithm models, constructed based on preoperative serum MMP7 and serological tests can diagnose BA more efficiently and accurately. The most important influencing factors for diagnosis are serum MMP7, serum GGT, and acholic stools.

Background Biliary atresia (BA) is the most common serious neonatal biliary disease, characterized by progressive biliary inflammation and fibrosis. We aim to comprehensively and systematically investigate the complex pathological process of BA from multiple molecular dimensions, combining transcriptomics, proteomics, metabolomics, and single-cell RNA sequencing. Methods Transcriptomic, proteomic, and metabolomic techniques were utilized for detecting and integrating the molecular characteristics of BA liver tissues. By combining single-cell RNA sequencing data, we were able to pinpoint the immune cells regulated by the abnormal metabolite in BA. In vitro experiments were detected to reveal the role and mechanism of the abnormal metabolite signaling pathway in the progression of BA. In vivo, the effect of inhibiting abnormal signaling pathway on alleviating bile duct injury and fibrosis was verified in the rotavirus type A (RRV) induced mouse model. Results We found the aberrant regulation and activation of the sphingolipid metabolism pathway was observed in BA by transcriptomic, proteomic, and metabolomic data analysis. By integrating BA single-cell RNA sequencing data, we found that Sphingosine-1-Phosphate Receptor 4 (S1PR4), a receptor of Sphingosine-1-Phosphate signaling, was primarily expressed in CX3CR1+CD8+ effector T (Teff) cells. In vitro experiments demonstrated that S1P promoted the migration of CX3CR1+CD8+Teff cells, and S1P/S1PR4 signaling facilitated the differentiation of CX3CR1+CD8+Teff cells into CD8+ tissue-resident memory T (TRM) cells. Co-culture of CD8+TRM cells could induce apoptosis of cholangiocytes. In the RRV mouse model, S1PR4 inhibitor could alleviate liver inflammation and fibrosis by inhibiting the accumulation of CD8+TRM cells (IDDF2024-ABS-0207 Figure 1. S1P S1PR4 promotes the differentiation of CD8 TRM cells aggravating bile duct injury in biliary atresia). Conclusions This study used multi-omics data integration to reveal aberrant regulation of the sphingolipid metabolism pathway in BA. The activated S1P/S1PR4 signaling pathway in BA liver recruited CX3CR1+CD8+Teff cells to accumulate around the cholangiocytes. S1P/S1PR4 signaling promoted the differentiation of CX3CR1+CD8+Teff cells into CD8+TRM cells, subsequently triggering apoptosis and injury of cholangiocytes, thus exacerbating the progression of BA. Targeting S1P/S1PR4 signaling activation is a promising therapeutic strategy for BA treatment.

Background Biliary atresia (BA) is a severe neonatal hepatobiliary disease that leads to progressive liver fibrosis and liver failure. Hepatic stellate cells (HSCs) have been identified as the main contributors to liver fibrogenesis, with their activation playing a crucial role in fibrosis development. Yiqihuoxue prescription (YQHX), a traditional herbal formula, has demonstrated effective anti-fibrotic properties in multiple hepatic diseases. This study aims to investigate the function and underlying mechanisms of YQHX in HSCs activation and liver fibrogenesis in BA. Methods We conducted a series of experiments using rhesus-rotavirus (RRV)-induced BA mice model and cultured HSCs. Neonatal mice were intraperitoneally injected with RRV within 12 hours of birth. Starting from day five, YQHX group received YQHX by oral gavage daily for 9 days. Pups were sacrificed on day 14 for tissue collection and analysis, and serum was collected to measure liver function. H&E and Masson's trichrome staining were performed for the examination of histological changes. A fibrosis model was established by inducing HSCs activation with tgfβ, and the effects of YQHX on cellular ferroptosis and fibrosis were investigated. UPLC-HRMS was utilized to identify the chemical components in YQHX, and molecular docking analysis was performed between them and NCOA4. Results We found that YQHX ameliorates hepatic injury and fibrosis in the RRV-induced BA mice model (IDDF2024-ABS-0308 Figure 1). In vitro experiments demonstrate that YQHX inhibits HSCs activation by suppressing their proliferation/migration and promoting apoptosis (IDDF2024-ABS-0308 Figure 2), which also occurs in the tgfβ-induced HSCs activation model (IDDF2024-ABS-0308 Figure 3, IDDF2024-ABS-0308 Figure 4). Mechanistically, we found that seven of the top ten compounds in YQHX exhibited molecular docking with NCOA4, a major regulator of ferritinophagy, thereby reducing the release of ferrous iron. We observed a decrease in NCOA4 expression with increasing YQHX concentration.YQHX enhanced the inhibition of activated HSCs after the knockdown of NCOA4 with lentivirus. Consequently, YQHX improved cellular iron overload and oxidative stress by inhibiting the expression of NCOA4, thereby suppressing the activation of HSCs (IDDF2024-ABS-0308 Figure 5). Conclusions YQHX can ameliorate hepatic fibrosis by targeting NCOA4 to induce the ferritinophagy of activated HSCs, providing a promising therapeutic strategy for hepatic fibrosis in BA.

目的 探讨先天性Ⅴ型食管闭锁的临床特点、诊治及预后情况.方法 回顾性分析2007年3月至2020年12月在首都医科大学附属北京儿童医院确诊并接受治疗的40例先天性V型食管闭锁患儿临床资料;其中男16例,女24例.收集并总结分析所有患儿临床表现及辅助检查结果、诊治经过及预后情况.结果 40例患儿中,27例(27/40,67.5％)于1岁内确诊.临床表现包括进食时呛咳、窒息、青紫(35/40,87.5％)以及反复肺部感染(25/40,62.5％).40例均经食管造影(阳性率97.4％)和(或)纤维支气管镜(阳性率100.0％)检查确诊.34例瘘管位于第7颈椎至第2胸椎水平,经颈部入路行气管食管瘘修补术;6例瘘管位于第2至第4胸椎水平,采用右侧胸膜外入路.32例治愈;1例术后造影发现第二条瘘管;5例出现喉返神经损伤;1例出现吻合口漏,经保守治疗1个月后痊愈;1例死于呼吸衰竭.36例获随访,3例失访;3例气管食管瘘复发,经再次手术后治愈;1例出现食管狭窄,经扩张5次后治愈.其余患儿生长发育正常,无不适表现.结论 先天性Ⅴ型食管闭锁临床症状不典型,易误诊,对可疑患儿行食管造影和纤维支气管镜检查有助于明确诊断.手术治疗效果良好,需警惕术后喉返神经损伤的可能.

Purpose To assess the growth status of children with recurrent tracheoesophageal fistula (rTEF), and determine the possible risk factors of growth retardation (GR). Methods The medical records of 83 patients with rTEF who underwent surgical repair were retrospectively analyzed. The patients were retrospectively divided into two groups according to whether they had GR. The clinical variables were compared between the GR and non-GR groups. Univariate and multivariable logistic regression analysis were performed to identify the risk factors for GR. Results Eighty-three children diagnosed with rTEF were included in this study. After a median follow-up of 31.4 (19.8, 48.7) months, GR occurred in 28 patients (33.7%). Among them, six patients with only weight for age Z score (WAZ) < -2SD, five patients with only height for age Z score (HAZ) < -2SD, and six patients with only BMI for age Z score (BAZ) < -2SD, while seven patients with both WAZ and HAZ < -2SD and four patients with both WAZ, HAZ and BAZ < -2SD. Multivariate logistic regression analysis showed that birth weight, anastomotic stricture and dysphagia after rTEF repair were independent risk factors with OR of 0.325 (0.119, 0.891), 4.396 (1.451, 13.324) and 5.341 (1.153, 24.752) for GR, respectively. Conclusions GR is a common complication after rTEF repair. Birth weight, anastomotic stricture and dysphagia after rTEF repair are independent risk factors affecting growth.

全膝关节置换术(TKA)是一项成熟的可缓解和治疗终末期膝关节骨关节炎和类风湿关节炎的手段.TKA术后下肢力线的重建以及假体的位置均与患者术后的满意度、假体的长期生存率密切相关,也是决定其临床效果的重要因素和评价指标.临床可通过X线、二维CT(2D-CT)、三维CT(3D-CT)等影像学技术对TKA术后下肢力线和假体的位置进行测量和评估,但目前尚无公认的金标准.2D-CT测量较X线在分析假体位置或松动、假体周围骨吸收、骨折、感染等方面的敏感性更高,而3D-CT对于轴面旋转的测量具有独特优势.相信随着计算机导航和机器人辅助技术的发展,3D-CT测量会逐渐成为TKA术后常用的测量方法.

Objective:To explore the related factors of thoracic infection after congenital esophageal atresia (CEA) surgery and to provide experiences for clinical diagnosis, treatment and prevention.Methods:From January 2007 to January 2022, clinical data were retrospectively reviewed for 207 children with type Ⅲ CEA undergoing surgery. There were 141 boys and 66 girls with a median weight of (2.90±0.49) kg and a median operative age of 4.0 days. The distance between distal and proximal ends of blind esophageal end was (1.66±1.03) cm. Other malformations were diagnosed in 84.1% (174/207). And 8.7% (18/207) of them were diagnosed as VACTERL syndrome, including cardiac malformations (n=17) , anorectal malformations (n=3) , spinal/pyramidal malformations (n=8) , urinary malformations (n=5) and 5 extremity malformations (n=5). Pneumonic manifestations were present preoperatively in 46.9% (97/207). They were divided into infection group (n=24) and non-infection group (n=183) according to the occurrence or not of postoperative thoracic infection. The inter-group differences in clinical characteristics were compared and the related factors of thoracic infection after CEA examined by univariate analysis.Results:Among them, 35.7% (74/207) underwent thoracoscopy and 64.3%(133/207) thoracotomy; 99 patients were operated by extrapleural approach and 108 by intrapleural approach. Postoperative complications included thoracic infection (n=24) , pneumothorax (n=94) , anastomotic leakage (n=74) , anastomotic stricture (n=73) and recurrent esophagotracheal fistula (n=13) . Thirty-one pathogenic bacteria were isolated from pleural fluid of children with thoracic infections, of which 58.1% (18/31) were Gram-positive bacteria and 41.9% (13/31) were Gramnegative bacteria. The incidence of pneumothorax was 91.7% (22/24) and anastomotic leakage 70.8% (17/24) in infected group; the incidence of pneumothorax was 39.3% (72/183) and anastomotic leakage 31.1% (57/183) in non-infected group. The incidence of thoracotomy , pneumothorax and anastomotic leakage was higher in infected group than that in non-infected group and the differences were statistically significant ( P<0.05) . However, no significant inter-group differences existed in gender, concurrent syndrome or distance between distal and proximal ends of blind esophageal end, preoperative pneumonia, operative age, surgical approach, postoperative mechanical ventilation, chest drainage tube indwelling duration or postoperative hospital stay ( P>0.05) . Conclusions:Thoracotomy for CEA is more prone to thoracic infection. And pneumothorax and anastomotic leakage may be closely correlated with the occurrence of thoracic infection.

BackgroundBiliary atresia (BA) is the most common cholestatic liver disease in neonates. Herein, we aimed at characterizing the gut microbiota and fecal bile acid profiles of BA patients, defining the correlations between them, and evaluating the relationship between the clinical pathogenesis and changes in the gut microbiota and bile acid profiles.MethodsA total of 84 fecal samples from BA patients (n = 46) and matched healthy controls (HCs, n = 38) were subjected to sequencing by 16S rRNA gene amplification, and fecal bile acid were analyzed by targeted metabolomics.FindingsCompared with the controls, a structural separation of the intestinal flora of BA patients was uncovered, which was accompanied by changes in the composition of fecal bile acids. In the BA group, Actinobacillus, Monoglobus, and Agathobacter were enriched in patients without cholangitis (p < 0.05). Selenomonadaceae and Megamonas were more abundant in patients without recurrent cholangitis episodes (p < 0.05), while Lachnospiraceae and Ruminococcaceae were enriched in patients with multiple recurrences of cholangitis (p < 0.05). Postoperative jaundice clearance was associated with Campylobacter and Rikenellaceae (p < 0.05), and tauroursodeoxycholic acid was associated with jaundice clearance (p < 0.001).ConclusionBA patients are characterized by different compositions of gut microbiota and bile acids, and their interaction is involved in the process of liver damage in BA, which may be closely related to the occurrence of postoperative cholangitis and jaundice clearance.

BACKGROUND:Although thoracoscopic surgery has become the routine surgical method for esophageal atresia/tracheoesophageal fistula (EA/TEF), thoracoscopic treatment for recurrent tracheoesophageal fistula (rTEF) is far from popularized. OBJECTIVES:We aimed to explore the safety and efficacy of thoracoscopic treatment for rTEF with a large-cohort study. METHODS:We retrospectively analyzed the clinical characteristics and outcomes of 103 consecutive patients who underwent thoracoscopic surgery for rTEF by one surgeon after EA/TEF repair at two different institutions in China from 2014 to 2021. RESULTS:One hundred and three pediatric patients (67 boys) were enrolled and the primary operations were performed via thoracoscopic (n = 75, 72.82%) or open surgery (n = 28, 27.18%). The median age at rTEF diagnosis was 5 (3, 10) months after the primary repair. Patients were diagnosed with recurrent fistula to the trachea (n = 97, 94.17%), bronchi (n = 4, 3.88%), and lung parenchyma (n = 2, 1.94%), and all of them underwent thoracoscopic surgery at a median age of 7 (5, 14) months with a median weight of 6200 (4870, 7650) g. After the repair of rTEF, the incidence of esophageal leakage, esophageal stricture, and TEF recurrence were 12.8%, 33.4%, and 10.8%, respectively. After the follow-up, 87 patients survived, 6 died, and 10 were lost to follow-up. CONCLUSIONS:The results of thoracoscopic surgery for rTEF were comparable with previously reported thoracotomy surgery. Owing to the clear field during the operation, rapid patient recovery and esthetic results, the thoracoscopic approach could be a better choice for experienced pediatric surgeons. LEVEL OF EVIDENCE:LEVEL IV.

Congenital H-type tracheoesophageal fistula (H-TEF) is a rare type of esophageal atresia.With the continuous development of ultrasound and magnetic resonance imaging (MRI) in the field of prenatal diagnosis in recent years, thoracoscopic surgery and endoscopic treatment, which are more minimally invasive than traditional open surgery, have also been carried out.Based on previous research reports, the diagnosis and treatment of congenital H-TEF was reviewed in this paper.