To determine whether continuous clamping improves distal fistula dissection in thoracoscopic type C esophageal atresia repair.

Between January 2019 and May 2024, 31 patients with type C esophageal atresia underwent thoracoscopic repair. Patients were randomly assigned to receive either conventional surgery (control group, n = 16) or surgery with continuous clamping during distal fistula dissection (study group, n = 15). This study compared intraoperative parameters (fistula dissection time, total surgical duration, etc.) and postoperative outcomes (anastomotic leak, anastomotic stenosis, etc.) between groups.

Baseline characteristics did not differ significantly between groups, including gender, age, admission weight, gestational age, and comorbid congenital anomalies (all P > 0.05). The study group demonstrated significantly fewer intraoperative interruptions (1.2 ± 0.3 vs. 5.5 ± 1.3 episodes, P < 0.05), shorter fistula ligation time (15.3 ± 4.5 vs. 32.3 ± 10.6 min), and shorter total operative duration (121.5 ± 13.5 vs. 153.1 ± 15.0 min) compared with the control group (all P < 0.05).

Continuous clamping during distal fistula dissection significantly reduces cyanosis-related surgical pauses, shortens fistula ligation time, and decreases total operative time, improving efficiency in thoracoscopic type C esophageal atresia repair.