To evaluate the clinical consequences of postoperative anastomotic leakage following esophageal atresia (EA) repair.
Approach:
Study Design: Retrospective review of patients with EA who underwent surgical repair at a single tertiary center from 2010 to 2024.
Patient Selection: 143 patients included; those with type E EA were excluded.
Data Collection: Clinical characteristics, operative variables, postoperative complications, feeding outcomes, and long-term esophageal morbidities were analyzed.
Statistical Analysis: Multivariable logistic regression analyses identified factors associated with anastomotic stricture and gastroesophageal reflux disease (GERD).
Key Findings:
36 (25.2%) developed anastomotic leakage.
Higher incidence of anastomotic stricture in leakage group (78% vs. 57%, p = 0.029).
Delayed feeding progression in leakage group, including longer times to feeding initiation (11 vs. 8 days, p = 0.022), oral feeding initiation (38 vs. 14 days, p = 0.005), achievement of full feeding (35 vs. 21 days, p = 0.037), and oral full feeding (58 vs. 26 days, p = 0.012).
Unplanned reoperations more frequent in leakage group (31% vs. 11%, p = 0.008).
Greater gap distance associated with increased risk of anastomotic stricture (adjusted OR 1.38, p = 0.026).
Anastomotic leakage associated with GERD (adjusted OR 2.60, p = 0.027).
Interpretation:
Anastomotic leakage after EA repair is linked to delayed feeding progression, increased esophageal morbidity, and a higher risk of unplanned reoperation.
Limitations:
Single-center study may limit generalizability.
Retrospective design may introduce selection bias.
Conclusion:
Patients with postoperative leakage represent a high-risk group that may require careful long-term surveillance and multidisciplinary follow-up.
