Percutaneous laparoscopic-assisted gastrostomy outperforms surgical gastrostomy for temporary feeding in long-gap esophageal atresia: a comparative cohort study

Abstract

Objective

This study aims to compare the clinical efficacy of percutaneous laparoscopic-assisted gastrostomy (PLAG) and surgical gastrostomy (SG) for temporary gastrostomy in neonates with long-gap esophageal atresia (LGEA).

Methods

We conducted a retrospective analysis of 41 neonates diagnosed with LGEA who underwent temporary gastrostomy. Patients were retrospectively divided into two groups based on the year of surgery: the PLAG group (intervention group, n = 23,post-2020) and the SG group (historical control group, n = 18, pre-2020).We compared perioperative parameters, including postoperative fasting duration, gastrostomy closure rates, abdominal scar scores and complication rates between the two groups.

Results

No significant differences were found in baseline characteristics, including gender (p = 0.732), gestational age (p = 0.460), birth weight (p = 0.421), operative age (p = 0.165), Gross classification (p = 0.117), esophageal gap length (p = 0.081), or concomitant deformities (p = 0.767). The two groups showed no statistically significant differences in operative time (p = 0.067), intraoperative blood loss (p = 0.189), or postoperative fasting duration (p = 0.378). However, the PLAG group demonstrated clinically meaningful advantages in several outcomes, including significantly lower rates of gastrostomy closure (p < 0.001), improved cosmetic results (assessed by lower abdominal scar scores; p < 0.001), and reduced complication rates for stoma leakage (p < 0.001), peristomal dermatitis (p < 0.001), local infection (p < 0.001), and tube dislodgement (p = 0.003). No significant differences were noted in stomal hemorrhage (p = 0.083) or intra-abdominal fistula rates (p = 0.252).

Conclusion

Compared to SG, PLAG offers significant advantages for temporary gastrostomy in LGEA, including lower closure requirements, improved cosmetic outcomes, and fewer overall complications. These findings support the broader clinical adoption of PLAG in this patient population.

Introduction

Esophageal atresia (EA) is a serious gastrointestinal malformation occurring in approximately 1 in 2500–4000 live births, among its types, Pure EA (without tracheoesophageal fstula) accounts for 8% of cases [1–3]. Long-gap esophageal atresia (LGEA), characterized by a defect too extensive for primary end-to-end anastomosis, includes pure EA (Gross type A) and EA with tracheoesophageal fistula with a wide gap (>2 cm, Cross type B and subtypes of Gross type C) [4]. Patients with LGEA typically require a staged surgical approach, where temporary gastrostomy provides essential enteral nutritional support and mechanical stretching of the lower esophagus via gastrostomy tract promotes elongation and facilitates delayed anastomosis [5], these are the two key considerations for performing a gastrostomy.

Various gastrostomy techniques have evolved over time. Traditional surgical gastrostomy (SG), first described by Stamm, involves laparotomy and purse-string suturing, which can lead to significant trauma and complications [6]. Although Janeway’s anti-reflux modification reduced some risks, issues like wound infection and stomal leakage persisted [7]. Minimally invasive techniques, such as percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG), have largely replaced open approaches due to their procedural simplicity and lower complication rates [8, 9].

However, in patients with anatomical constraints or disrupted esophageal continuity, conventional PEG or PRG is not feasible. In these cases, percutaneous laparoscopic-assisted gastrostomy (PLAG) has emerged as a safer alternative, offering direct visualization to minimize visceral injury and reduce complications [10, 11].

Despite advancements, evidence comparing PLAG and SG in the LGEA population is limited, particularly regarding operative duration, complications, closure timing, cosmetic results, and safety profiles. To address these gaps, we conducted a retrospective review of 41 consecutive LGEA patients treated over a 10-years period (2014–2024), comparing clinical outcomes of PLAG and SG to inform personalized surgical strategies in this high-risk neonatal population.

Materials and methods

Patient selection and study design

A retrospective analysis was conducted on infants diagnosed with LGEA who underwent gastrostomy at the Department of Neonatal Surgery, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, from January 2014 to December 2024. This study employed a historical control group design to compare outcomes between two distinct time periods. Patients who underwent surgical gastrostomy (SG, n = 18) before 2020 were designated as the historical control group, while those who received percutaneous laparoscopic-assisted gastrostomy (PLAG, n = 23) from 2020 onward formed the intervention group.The transition to PLAG was driven by its demonstrated advantages in minimizing surgical trauma and reducing complications. Crucially, all procedures were performed by the same surgical team using consistent preoperative evaluations and postoperative protocols. Preoperative evaluations included laboratory tests, imaging assessments, bronchoscopy for atresia classification, and congenital anomaly screening. The study protocol was approved by the Medical Ethics Committee of Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital (Approval No [2025]4−2).

Inclusion criteria

Patients with typical clinical manifestations of LGEA, confirmed through imaging studies and bronchoscopy, who provided informed consent from legally authorized guardians, and met surgical indications without absolute contraindications were included.

Exclusion criteria

Cases where guardians declined surgical intervention, had absolute surgical contraindications(e.g.,severe coagulopathy, intra-abdominal infection, and intestinal obstruction or gastrointestinal perforation), lacked complete key clinical documentation, were referred with prior gastrostomy performed elsewhere, or were non-LGEA cases requiring gastrostomy were excluded.

Surgical procedures

Gastrostomy is typically performed immediately after excluding surgical contraindications, usually within 1 to 2 days following a definitive diagnosis. Preoperative management included fasting, continuous negative pressure suction via an upper esophageal drainage tube, airway clearance, temperature maintenance, antibiotic prophylaxis, correction of fluid and electrolyte imbalances, and respiratory support based on pulmonary function assessments. Postoperatively, neonates were transferred to the Neonatal Intensive Care Unit (NICU) for continuous monitoring, mechanical ventilation as needed, secure fixation of the gastrostomy tube, enhanced airway management, and systematic wound care. Parenteral nutrition was administered via central venous access.

PLAG

Following endotracheal intubation under general anesthesia, patients were positioned supine. A 5-mm umbilical incision was made to establish CO₂ pneumoperitoneum, maintained at 6–8 mmHg. A 5-mm trocar was inserted, and a 30° laparoscope was deployed for abdominal exploration. Two additional 3-mm auxiliary incisions were created bilaterally near the umbilicus for instrument access. Key procedural steps included site selection, suspension suturing, gastric access, reinforced fixation, and closure, as shown in Fig. 1.

Fig. 1.

PLAG Procedure. A A full-thickness “abdominal wall–gastric wall” suspension suture is placed B A full-thickness U-shaped “spacer–abdominal wall–gastric wall” suture is applied C The gastric wall is closely attached to the abdominal wall D Completion of the PLAG procedure

SG

The Stamm gastrostomy procedure, with one minor modification: we have replaced the conventional longitudinal incision with a transverse incision. After general anesthesia with endotracheal intubation, a 2–3 cm transverse left upper abdominal incision was made for layered laparotomy. The left hepatic lobe and colon were retracted to expose the avascular zone of the anterior gastric wall. Surgical steps included gastric mobilization, placement of purse-string sutures, creation of the gastrostomy, catheter placement, and fixation.

Around 2 weeks after the gastrostomy surgery, a metal bougie was placed into the distal pouch via gastrostomy and elongation was performed using the bougie to provide upward pressure simultaneously. The surgeon evaluated the distal esophageal gaps, shape, and flexibility. Distal bougienage stretching was performed for 10–15 mins in a ward each day and usually by a certain doctor for one certain patient because he can roughly know the direction and how to adjust the angle of the bougie, and esophagography was erformed every 2 weeks to evaluate esophageal growth and distance.

Outcome measures and follow-up

Perioperative and postoperative follow-up data were systematically collected and analyzed to compare outcomes between the two groups. Key parameters included baseline characteristics (gender, gestationalome measures and follow-uage, birth weight, operative age, Gross classification, esophageal gap length, and concomitant deformities), surgical metrics (operative time, intraoperative blood loss, postoperative fasting duration, and gastrostomy closure rate), and postoperative outcomes (abdominal scar assessment and incidence of complications).

Postoperative fasting duration was defined as the time from gastrostomy completion to the initiation of enteral feeding via the gastrostomy tube. Gastrostomy-tube enteral feeding initiation in post-gastrostomy neonates necessitates multifactorial clinical assessment, Criteria for Initiating Enteral Feeding : (1)Neonates must exhibit stable hemodynamics (e.g., no shock or severe infection) and absence of metabolic derangements (e.g., acidosis, electrolyte imbalances); (2)Resumption of intestinal motility (e.g., normal bowel sounds, absence of significant abdominal distension) and confirmation of intestinal patency without obstruction or perforation risk through clinical assessment or imaging studies are prerequisites; (3)Correct positioning of the gastrostomy tube (verified by imaging confirmation) and patency of the tube without risk of occlusion or dislodgement are essential.

Gastrostomy closure was assessed if the stoma did not close spontaneously within 2 weeks after tube removal following esophageal reconstruction. Closure of a gastrostomy primarily involves the complete dissection of the gastric and abdominal walls, repair of the gastric tissue, and excision of the fistula tract and scarred abdominal wall tissue.

Abdominal scar assessment was conducted more than 6 months post-tube removal using the Scar Cosmesis Assessment and Rating (SCAR) scale, the SCAR scale provides a unique combination of an out- come measure designed for linear scars that maybe used by examining photographs, not the live patients, and that may be completed in less than 1 min by most raters [12], as shown in Table 1.

Table 1.

The Scar Cosmesis Assessment and Rating (SCAR) scale

Parameter	Descriptor	Score
Clinician Items
Scar spread	None/near invisible	0
	Pencil-thin line	1
	Mild spread, noticeable on close inspection	2
	Moderate spread, obvious scarring	3
	Severe spread	4
Erythema	None	0
	Light pink, some telangiectasias may be present	1
	Red, many telangiectasias may be present	2
	Deep red or purple	3
Dyspigmentation	Absent	0
	Present	1
Suture marks	Absent	0
	Present	1
Hypertrophy/atrophy	None	0
	Mild: palpable, barely visible hypertrophy or atrophy	1
	Moderate: clearly visible hypertrophy or atrophy	2
	Severe: marked hypertrophy or atrophy or keloid formation	3
Overall impression	Desirable scar	0
	Undesirable scar	1
Patient Items
Itch	No	0
	Yes	1
Pain	No	0
	Yes	1
Total score range	0 (best possible score) to 15 (worst possible score)

Complications, including stoma leakage, peristomal dermatitis, local infections, Tube dislodgement, stoma hemorrhage and intra-abdominal fistula formation, were recorded to provide a comprehensive overview of the safety and efficacy of each surgical approach.

Statistical analysis

Statistical analyses were performed using SPSS 29.0 software. Continuous variables with a normal distribution were expressed as mean ± standard deviation (mean ± SD) and compared using the Student’s t-test. Non-normally distributed variables were presented as median and interquartile range [M (P25, P75)], with comparisons made using the Wilcoxon rank-sum test. Categorical data proportions were analyzed using the continuity-corrected chi-square test. This approach ensured a robust evaluation of outcome differences between the two surgical techniques.

Results

Patient characteristics

A total of 41 patients with LGEA successfully underwent gastrostomy, comprising 23 patients who received PLAG and 18 patients who underwent SG. The baseline characteristics were compared between the two groups.

Demographic profiles indicated similar distributions in gender, gestational age, birth weight, and operative age. Both groups exhibited similar classification of EA and the differences in the length of EA are also not reflected. Additionally, concomitant deformities were noted in 10 PLAG cases and 7 SG cases, with no significant differences between the groups.That as shown in Table 2.

Table 2.

Demographic Characteristics of All Participants

Parameter	PLAG group (n = 23)	SG group (n = 18)	t/χ2 -value	P
Gender				0.732
male	14	10
female	9	8
Gestational age (w)	37.10 ± 2.06	37.17 ± 1.65	0.102	0.460
Birth weight (kg)	2.53 ± 0.45	2.56 ± 0.40	0.204	0.421
Operative age (d)	3.22 ± 1.12	3.56 ± 1.04	0.986	0.165
Gorss classification				0.117
Type A	9	3
Type C	14	15
Esophageal gap length (cm)	3.42 ± 0.87	3.08 ± 0.60	−1.427	0.081
Concomitant deformities	10	7		0.767
ventricular septal defect	1	1
patent ductus arteriosus	2	1
anal atresia	2	1
polydactyly/syndactyly	1	1
congenital thumb aplasia	1
chromosomal abnormality	1
hypospadias		1
VACTERL association	2	2

Operative and postopent outcomes

The comparative analysis demonstrated significant advantages of PLAG over SG across several parameters. Operative metrics revealed that the PLAG group had a shorter operative time and reduced intraoperative blood loss.Postoperative recovery also favored PLAG, with shorter fasting periods and significantly lower rates of gastrostomy closure. Furthermore, more than six months after gastrostomy tube removal, abdominal wall scar assessments indicated better cosmetic outcomes in the PLAG group, as evidenced by lower SCAR scale scores.That as shown in Table 3.

Table 3.

Intraoperative and Postoperative outcomes

Parameter	PLAG group(n = 23)	SG group(n = 18)	t/χ2 -value	P
Operative time(min)	68.70 ± 8.52	75.83 ± 9.36	2.548	0.067
Intraoperative blood loss(ml)	2.16 ± 0.36	2.67 ± 0.84	0.644	0.189
Postoperative fasting duration(d)	2.39 ± 0.99	3.00 ± 1.09	4.908	0.378
Gastrostomy closure rate(%)	4.3(1/23)	88.9(16/18)	29.734	<0.001
Abdominal scar assessment(pts)	3.57 ± 1.08	4.89 ± 1.02	3.986	<0.001

Complications

The analysis of postoperative complications revealed significant differences between the two surgical approaches. PLAG showed a marked reduction in complications compared to SG. Specifically, the rates of stoma leakage, peristomal dermatitis and local infections were substantially lower in the PLAG group. Tube dislodgement rates were also significantly reduced in the PLAG cohort. However, the incidence rates of stoma hemorrhage and intra-abdominal fistula formation were similar between the two groups, with no statistically significant difference observed.That as shown in Table 4.

Table 4.

Postoperative complications

Parameter	PLAG group (n = 23)	SG group (n = 18)	F/χ2 -value	P
Stoma leakage	17.4% (4/23)	88.9% (16/18)	20.659	<0.001
Peristomal dermatitis	17.4% (4/23)	88.9% (16/18)	20.659	<0.001
Local infection	17.4% (4/23)	88.9% (16/18)	20.659	<0.001
Stomal hemorrhage	4.3% (1/23)	22.2% (4/18)	3.013	0.083
Tube dislodgement	8.7% (2/23)	50% (9/18)	8.775	0.003
Intraperitoneal fistula	0%	5.56% (1/18)	1.310	0.252

Gastrostomy closure

In terms of gastrostomy closure, the SG group required closure in 16 cases(88.9%), with only 2 achieving spontaneous closure after tube removal. In contrast, the PLAG group achieved spontaneous closure in 22 out of 23 cases (95.7%), with most closures occurring within 2 weeks post-tube removal. This significant difference avoids reoperation, reduces costs, and minimizes anesthesia exposure.

Additionally, the SG group had significantly higher SCAR scale scores, reflecting higher reoperation rates and poorer cosmetic outcomes, as shown in Fig. 2.

Fig. 2.

Abdominal Wall Scars at Least 6 Months Post-Gastrostomy Tube Removal. A Scar condition following surgical gastrostomy (SG) B Scar condition following the PLAG procedure

Discussion

In the management of LGEA, temporary gastrostomy placement is considered a key measure to ensure enteral nutrition and promoting gastric development, albeit with variable adoption rates across medical centers [13, 14]. Advancements in gastrostomy techniques have prompted a paradigm shift toward procedures that prioritize minimal invasiveness, technical simplicity, accelerated perioperative recovery, reduced postoperative complication risks, minimized requirements for gastrostomy site closure, and controlled abdominal wall scarring with aesthetic acceptability.This study demonstrates the superior efficacy of PLAG over SG in delivering temporary enteral nutrition for LGEA patients.

In addition to providing nutritional support, through the gastrostomy tract, X-ray contrast imaging can be used to identify the position of the distal esophagus, meanwhile mechanical elongation within the esophageal lumen can be induced via traction using a metal probe, that was performed to create the necessary anatomical conditions for delayed primary esophageal anastomosis [15, 16].This method proves effective in elongating the esophagus, as exemplified by the well-established Foker and Kimura techniques. Functionally, gastrostomy serves three critical roles in LGEA management: nutritional stabilization, anatomical preparation, and therapeutic staging. The refinement of this technique directly influences surgical success rates and long-term quality of life, highlighting its crucial role in bridging therapeutic phases until definitive esophageal continuity is achieved.

Minimally invasive pediatric surgery has popularized PLAG as a first-line approach, offering direct visualization and lower complication rates [17, 18]. Our PLAG procedure employs three trocars (one 5-mm observation port and two 3-mm operating ports). The dual operating ports facilitate efficient U-suture placement between the stomach and abdominal wall, reducing gastroduodenal tension, minimizing gastric wall tearing risk, and enhancing gastrostomy positioning precision. Some peers, successfully complete the procedure with only one 5-mm observation and one 3-mm operating port, but the fundamental procedure of the U-stitch technique remains invariant. The selection of the number of trocar depends on the surgeon’s preference and skill level. For beginners, three trocars offer a safe and reliable approach. For centers with limited laparoscopic resources, mini-laparotomy-assisted percutaneous gastrostomy (MLAG) achieves comparable outcomes [19]. MLAG is particularly advantageous for extremely preterm infants and ventilator-dependent neonates, as it avoids pneumoperitoneum-related complications and reduces anesthesia exposure.

Although, the two groups showed no statistically significant differences in postoperative fasting duration (p = 0.378)，we still stress the importance of establishing enteral feeding at an early stage，because early enteral feeding initiation is associated with improved functional recovery and reduced postoperative complications in pediatric surgical populations [20]. Although the postoperative fasting duration in both groups was relatively short, it was longer than that reported for other conditions requiring gastrostomy. Enteral feeding was initiated within 24 hours postoperatively in many pediatric patients, with full enteral nutrition achieved within 48 hours. Just as Wiernicka et al. [21] demonstrated no significant differences in feeding tolerance (81.6% vs.91.6%) or complication rates (25.5% vs.37.5%) among 97 patients, with full feeding achieved within 24–48 hours in most cases (74% vs.82%). In LGEA, this discrepancy arises from three key factors in our clinical setting: (1) prolonged mechanical ventilation is common in infants with pulmonary hypoplasia, lung infection, or tracheal fistula ligation; (2) extended sedative administration delays gastrointestinal motility recovery; (3) X-ray contrast imaging is required before enteral feeding to confirm gastrostomy tube positioning, exclude peritoneal leakage, and assess intestinal patency to rule out obstruction/perforation risks. Based on our experience, meeting all criteria typically takes more than 2 days post-procedure, leading us to initiate feeding around this timeframe.

We observed that intraoperative and postoperative gastrostomy tube radiography in infants with long-gap esophageal atresia (LGEA) revealed reduced gastric capacity, characterized by a narrow, elongated gastric morphology, particularly evident in pure esophageal atresia.Therefore, the anterior gastric wall in the avascular region between the greater and lesser curvatures is preferable as the stoma site, as this minimizes gastric traction and pyloric obstruction risk. Meanwhile, when initiating enteral nutrition via gastrostomy, it is advisable to commence with minimal enteral feeding using a continuous infusion pump, followed by a gradual transition to avoid premature, rapid advancement to full enteral nutrition. This strategy is critical for preventing gastric overdistension and feeding intolerance. Vigilant monitoring of abdominal signs and bowel movements is essential for early detection of gastrointestinal complications, such as necrotizing enterocolitis in neonates.

Our study demonstrated that the PLAG group exhibited a statistically significantly lower early complication rate (17.4%) compared to the SG group (88.9%), with no late complications reported in the PLAG group versus a 5.5% late complication rate in the SG group. Statistically significant differences were observed in stoma leakage , peristomal dermatitis , local infection and tube dislodgement. However, no significant differences were found in stoma hemorrhage or intraperitoneal fistula rates. These findings align with Piñar-Gutiérrez et al.[22], who reported complication rates of 48.9% (PEG-PULL), 23.7% (PEG-PUSH), 41.26% (PLAG), and 87.3% (SG) in a cohort of 1070 pediatric patients, including two deaths (0.18%) and severe complications such as peritonitis (1.68%) and gastrojejunal fistula (0.4%).

Stoma leakage (see Fig. 3A), the most frequent complication (48.8%), primarily resulted from local infection, increased gastric acid secretion, buried bumper syndrome, or improper tube fixation [23]. Management strategies included tube repositioning, upsizing, suturing to reduce stoma size, and jejunal feeding tube placement, supplemented with prokinetics or proton pump inhibitors. In this study, each LGEA patient exhibited progressive worsening of stoma dilation and leakage, which was attributed to the cumulative mechanical stimulation induced by daily esophageal lengthening procedures, therefore, larger-diameter gastrostomy tubes were periodically replaced. Peristomal dermatitis (see Fig. 3B) and local infection (see Fig. 3C) often formed a vicious cycle (“leakage → dermatitis → infection → re-leakage”) due to acidic fluid exposure and delayed wound care, leading to granulation tissue (see Fig. 3D), pain, and agitation [24]. Standardized protocols—sterile dressing changes, waterproof foam dressings, stoma care powders, and ostomy pouches (see Fig. 3E)—effectively mitigated these issues [25] .

Fig. 3.

Complications and Management of Gastrostomy. A Stoma leakage B Peristomal dermatitis C Local infection D Granulation tissue formation around the stoma E Care of the enterostomy bag for gastrostomy F Insertion of a jejunal nutrition tube through the gastrostomy

Stomal hemorrhage was mainly caused by friction from the gastrostomy tube, managed by adjusting the tube position and applying local compression. Notably, one case of stoma-related intraperitoneal fistula occurred in the SG group, postoperative gastrography demonstrated minor contrast leakage via the common channel into the peritoneal cavity.primarily due to premature tube dislodgement before gastrostomy tract maturation. The management strategy involved extending the fasting duration, repositioning the gastrostomy site, followed by placement of a jejunal feeding tube via the gastrostomy (see Fig. 3F), and intensifying enteral feeding protocols, ultimately leading to successful fistula closure,without the need for surgical intervention.

In terms of gastrostomy closure, the SG group required closure in 16 cases, with only 2 achieving spontaneous closure after tube removal. In contrast, the PLAG group achieved spontaneous closure in 22 of 23 cases (95.7%, p < 0.001), with 95.7% sealing within 2 weeks. In the PLGA group, spontaneous stoma closure occurs post-tube removal due to the absence of gastric mucosal eversion during surgery, resulting in a non-secretory common tract that undergoes granulation closure similar to abdominal drainage sites. By contrast, surgical gastrostomy involves mucosal eversion and suture fixation to skin, maintaining a functional gastric-lined tract with persistent secretion. This mucosal continuity creates a biological barrier against spontaneous healing, necessitating surgical excision for closure. Corsello et al. [26] recently highlighted endoscopic closure techniques, such as over-the-scope clips, have emerged as promising alternatives, offering shorter operative times and comparable outcomes. Additionally, the SG group had higher SCAR scale scores, indicating greater reoperation rates and poorer cosmetic outcomes. These findings underscore the advantages of the percutaneous approach, aligning with modern aesthetic and functional priorities in pediatric minimally invasive surgery, while enhancing closure rates and improving patient satisfaction.

This single-center retrospective cohort study inherently has limitations, including a small sample size and reliance on institutional data, which collectively constrain the generalizability of our findings. The primary limitation lies in the control group representing historical controls, which could confound the interpretation of outcomes by introducing variations in concurrent nursing interventions. Future research should emphasize the necessity of multi-institutional cohort studies utilizing standardized treatment protocols and uniform outcome assessment frameworks to mitigate these limitations.

Conclusion

In conclusion, PLAG exhibits superior clinical efficacy and safety compared to SG for temporary gastrostomy in LGEA. PLAG offers advantages such as fewer closure procedures, improved aesthetics, and lower complication rates. These benefits align with modern pediatric surgical goals of minimally invasive procedures and faster recovery. Based on these results, PLAG is recommended as the preferred method for temporary gastrostomy in LGEA, especially in centers with proficient laparoscopic skills.

Author contributions

W-HL, WL and TZ: conception and design of the research.Y-ML, S-WM, X-RH, J-HG andF-JH : acquisition of data. W-HL, G-JH and TZ: analysis and interpretation of the data. MH and Z-QO: statistical analysis. W-HL and WL: writing of the manuscript. TZ and J-BC: critical revision of the manuscript for intellectual content. All authors ontributed to the article and approved the submitted version.

Funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The manuscript was funded by the Guangxi Clinical Research Center for Pediatric Diseases (No: Guike AD22035121) and the innovation and Clinical Research in the Diagnostic and Therapeutic System for Congenital Esophageal Atresia(No: GZLSF-3).

Data availability

No datasets were generated or analysed during the current study.

Declarations

Conflict of interest

The authors declare no competing interests.