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Background <p>Esophageal atresia (EA) is a life-threatening congenital anomaly requiring surgical repair. The choice between primary (one-stage) and staged repair remains debated, particularly in neonates with long-gap EA or comorbidities. Evidence from resource-limited settings is scarce.</p> Methods <p>We retrospectively reviewed 115 neonates with EA who underwent surgical repair at Motahari Pediatric Hospital, Iran (2017–2024). Patients were classified into one-stage or staged repair groups. Demographics, associated anomalies, complications, operative time, hospital stay, and survival were analyzed using appropriate statistical tests.</p> Results <p>Of 115 patients, 68 underwent one-stage repair and 47 staged repair. Baseline characteristics were comparable, though Type A EA was more frequent in staged cases. Postoperative complication rates, including anastomotic stricture, leak, pneumonia, and sepsis, were similar between groups. Failed gastrostomy was significantly higher in staged repair (<i>p</i> = 0.01). Survival rates were comparable (79.4% vs. 78.7%). Mean operative time and hospital stay were longer in the staged group but not statistically significant. Gestational age showed a significant inverse correlation with operative duration (ρ = − 0.225, <i>p</i> = 0.016).</p> Conclusion <p>One-stage and staged repairs demonstrated comparable short-term outcomes in EA. Individualized surgical planning, considering gestational age, gap length, and comorbidities, is essential. These findings highlight that acceptable outcomes can be achieved even in resource-limited settings, supporting tailored decision-making rather than universal preference for either technique.</p>

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Comparative analysis of outcomes of one stage versus staged surgical repair in esophageal atresia: an audit from a tertiary pediatric center in low resources country

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  • 发表日期：

    2025年11月19日

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  • Rahman Khosravi,
  • Hatef Alizadeh,
  • Reyhaneh Aftabi

摘要

Background

Esophageal atresia (EA) is a life-threatening congenital anomaly requiring surgical repair. The choice between primary (one-stage) and staged repair remains debated, particularly in neonates with long-gap EA or comorbidities. Evidence from resource-limited settings is scarce.

Methods

We retrospectively reviewed 115 neonates with EA who underwent surgical repair at Motahari Pediatric Hospital, Iran (2017–2024). Patients were classified into one-stage or staged repair groups. Demographics, associated anomalies, complications, operative time, hospital stay, and survival were analyzed using appropriate statistical tests.

Results

Of 115 patients, 68 underwent one-stage repair and 47 staged repair. Baseline characteristics were comparable, though Type A EA was more frequent in staged cases. Postoperative complication rates, including anastomotic stricture, leak, pneumonia, and sepsis, were similar between groups. Failed gastrostomy was significantly higher in staged repair (p = 0.01). Survival rates were comparable (79.4% vs. 78.7%). Mean operative time and hospital stay were longer in the staged group but not statistically significant. Gestational age showed a significant inverse correlation with operative duration (ρ = − 0.225, p = 0.016).

Conclusion

One-stage and staged repairs demonstrated comparable short-term outcomes in EA. Individualized surgical planning, considering gestational age, gap length, and comorbidities, is essential. These findings highlight that acceptable outcomes can be achieved even in resource-limited settings, supporting tailored decision-making rather than universal preference for either technique.