Complications After Surgical Repair of Esophageal Atresia: Insights from a Single-Center Experience

N Kechiche¹, N Boukhrissa¹, m Elouer², R Lamiri¹, H Hmida², M Mekki³, L Sahnoun¹

¹department of pediatric surgery , University Hospital of Monastir
²Neonatal intensive care department, University Hospital of Monastir
³Department of Pediatric Surgery, Monastir University Hospital, Tunisia

Introduction:
Esophageal atresia (EA) remains a challenging congenital anomaly that requires a multidisciplinary approach, combining surgical precision and effective neonatal intensive care. Despite advances in diagnosis and perioperative management, postoperative complications continue to impact patient outcomes. This study presents a 14-year retrospective review of EA cases managed in our institution, with a focus on the incidence and management of postoperative complications.

Methods:
We conducted a retrospective study, including all children operated for EA between January 2005 and December 2018.

Results:
A total of 285 patients were included. Type III EA was the most common form (88%). Associated congenital anomalies were found in 11% of cases. Primary esophageal anastomosis was achieved in most patients (n = 248). In long-gap EA (n = 37; 13%), initial management included gastrostomy with esophagostomy in 3 patients, and gastrostomy with continuous upper pouch suction in the remaining cases.
The postoperative complication rate was significant. Anastomotic leakage occurred in 2% of cases, recurrent tracheoesophageal fistula in 0.4%, and anastomotic stricture in 28% of cases, requiring endoscopic balloon dilatation. Five children (1.7%) underwent esophageal replacement with a colonic graft. In addition, 23 patients (8%) underwent surgical intervention for gastroesophageal reflux disease (GERD) unresponsive to medical therapy.

Conclusion:
Although surgical techniques and neonatal care have significantly improved, postoperative complications such as anastomotic strictures and gastroesophageal reflux remain prevalent following EA repair. Early recognition, systematic follow-up, and multidisciplinary coordination are crucial to reducing long-term morbidity. Our findings underscore the need for standardized postoperative protocols and emphasize the value of close collaboration between surgeons, intensivists, and gastroenterologists to ensure optimal functional outcomes.

Keywords: Esophageal atresia,postoperative complications, outcome, management

N Kechiche¹, N Boukhrissa¹, m Elouer², R Lamiri¹, H Hmida², M Mekki³, L Sahnoun¹

¹department of pediatric surgery , University Hospital of Monastir
²Neonatal intensive care department, University Hospital of Monastir
³Monastir Üniversite Hastanesi, Çocuk Cerrahisi Bölümü, Tunus

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