Abstract:Objective To compare the curative effect between extrapleural approach and thoracoscopic surgery in the treatment of congenital esophageal atresia（EA）. Methods The clinical data of 99 children with type Ⅲ congenital EA treated with surgery in Xi'an Children's Hospital from February 2013 to June 2019 were collected. Out of all patients receiving one-stage ligation of esophagotracheal fistula and end-to-end anastomosis, there were 69 cases in extrapleural approach group （thoracotomy） and 30 cases in thoracoscopy group （minimally invasive）. The operation time, ventilator supporting time, hospital stay and postoperative complications were compared between two groups. Results There was no death during hospitalization. The median operation time was 2.40h in extrapleural approach group and 3.70h in thoracoscopy group. The median time of ventilator service after operation was 3.00 d in extrapleural approach group and 6.00 d in thoracoscopy group. There were significant differences in them between two groups（Z=6.320, 3.558, P＜0.01）. There was no significant difference in the median length of hospital stay after operation between extrapleural approach group and thoracoscopy group（19.00 d vs 22.80 d, Z=1.640, P=0.101）. The incidences of anastomotic leakage, anastomotic stenosis, pneumothorax, recurrence of esophagotracheal fistula and subcutaneous emphysema in extrapleural approach group were significantly lower than those in thoracoscopy group （P＜0.01,P＜0.05）. Conclusion Thoracoscopic treatment of congenital esophageal atresia and tracheoesophageal fistula has no advantage in shortening operation time and reducing postoperative complications and economic expenditure,which may be related to the lack of certain surgical experience,however, it has certain advantages in reducing surgical trauma, surgical incisions and complication related to chest wall deformity. Thoracotomy is more recommended before thoracoscopic surgery can be carried out maturely.