Esophageal atresia (EA) is a congenital anomaly with significant morbidity, particularly in low- and middle-income countries. This study aimed to evaluate short-, medium-, and long-term outcomes of EA in a Tunisian tertiary center.
We retrospectively reviewed all neonates treated for EA between 2018 and 2023. Data were collected from medical records and operative reports, including demographics, associated anomalies, surgical details, and outcomes.
Fifty-three patients were included (67.9% male; 76.5% outborn). Maternal comorbidities were present in 26.4%, mainly gestational diabetes (50%) and preeclampsia (24.1%). Antenatal diagnosis occurred in 11.3%. Prematurity was noted in 22.6%, and 28.3% had birth weight <2000 g.
Diagnosis was immediate in 52.8% (median 0 [0–3] h), and based on respiratory distress (45.3%), hypersalivation (43.4%), or choking (17%) in others. Type III EA accounted for 86.3%. Associated anomalies were present in 54.7%, including VACTERL (46.4%) and congenital heart defects (50% atrial septal defect). Preoperative ventilation was required in 80%; 9.4% died before surgery. Surgery was performed at a median age of 24 h [16–60], via right thoracotomy (70.8% extrapleural). Primary anastomosis was achieved in 91.7%, with tension-free repair in 77.3%.
Early complications (<30 days) occurred in 95.8%, mainly infectious (70.8%) and respiratory. Anastomotic leak occurred in 3 cases (1 fatal). Postoperative mortality was 8.4%. Median ventilation duration was 4 days [1–21].
Late complications (>30 days) occurred in 63.6%, including GERD (43.2%), anastomotic stricture (26.4%), recurrent infections (25%), and tracheomalacia (11.4%). Endoscopic dilatation was required in most strictures. Failure to thrive affected 18.9%; psychomotor delay 9.4%. Median follow-up was 50 months [34–72].
Despite high morbidity, postoperative mortality was low and comparable to high-income countries. Long-term follow-up showed manageable complications and acceptable functional outcomes, highlighting the impact of structured neonatal care in resource-limited settings.
Keywords: Esophageal atresia, neonates, associated malformations, anastomotic leakage, gastroesophageal reflux
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