ADVANCES IN THE TREATMENT OF CONGENITAL ESOPHAGEAL ATRESIA – A REVIEW OF SURGICAL TECHNIQUES AND LONG-TERM OUTCOMES

Background: Congenital esophageal atresia (EA) is a rare developmental anomaly characterized by discontinuity of the esophagus, frequently accompanied by a tracheoesophageal fistula. It affects approximately 1 in 2,500 to 4,000 live births and is often associated with other congenital anomalies. Advances in neonatal intensive care, surgical techniques, and postoperative support have markedly improved survival rates, yet long-term morbidity remains substantial. Aims: This review aims to provide a comprehensive and current analysis of surgical strategies for EA repair, critically appraising the available evidence on long-term outcomes and evaluating emerging multidisciplinary management approaches. Methods: A narrative review was conducted using PubMed, Embase, and Google Scholar to identify peer-reviewed articles published in English between 2015 and January 2025. Inclusion criteria encompassed studies on surgical techniques, clinical and functional outcomes, complications, and long-term management of EA. A total of 31 articles, including original research, systematic reviews, and meta-analyses, were selected. Article selection was performed manually by reviewing titles, abstracts, and full texts, with additional studies identified through reference list screening of included articles. Results: Surgical management of EA has progressed from traditional open thoracotomy to thoracoscopic approaches that reduce musculoskeletal morbidity and improve cosmetic outcomes. Primary anastomosis remains standard in short-gap EA, whereas delayed or staged interventions are preferred in long-gap cases. Despite improved survival rates (>90% in high-income settings), long-term complications such as anastomotic strictures, gastroesophageal reflux, dysphagia, and respiratory morbidity remain frequent. Minimally invasive techniques demonstrate comparable safety and efficacy to open repair in selected patients but require advanced surgical expertise. Lifelong multidisciplinary follow-up involving gastroenterology, pulmonology, nutrition, and psychology is essential to improve functional outcomes and quality of life. Conclusions: While survival in EA has markedly improved, the condition remains a lifelong disorder with significant long-term morbidity. The evidence base is limited by the predominance of retrospective studies, heterogeneity in outcome definitions, and variable follow-up durations. Surgical decisions should balance technical feasibility with long-term quality of life, and future research should prioritize standardized outcome measures, multicenter prospective studies, and optimized follow-up protocols.