Twenty-four years of esophageal atresia management: Evolution of practice and outcomes in a tertiary pediatric surgery center

Objectives: This study aims to evaluate clinical outcomes, operative approaches, and associated challenges in esophageal atresia (EA) patients treated over 24 years at our institution. Patients and methods: This retrospective observational study included 97 EA patients (60 males, 37 females, mean age 5.7 years; range, 4 month to 17.2 years) managed between January 2000 and January 2024. Patient data, including demographics, prenatal findings, EA types, associated anomalies, operative details, and complications, were collected from hospital records. Cases without complete data were excluded from analysis. Results: The male-to-female ratio was 1:0.65. The median birth weight was 2400 g, and the median gestational age was 37 weeks. Prenatally, polyhydramnios was present in 33 patients, with definitive diagnosis in 17. Esophageal atresia types included type A (n=11), type B (n=1), type C (n=83), and type D (n=2). Primary esophageal repair was achieved in 81 cases. Anastomotic strictures (15%) and GERD requiring intervention (20%) were the most common complications. Mortality was 16%, predominantly related to severe cardiac anomalies and pulmonary hypertension. Conclusion: Advances in neonatal intensive care, pediatric anesthesia, and surgical techniques have significantly improved EA outcomes at our institution. Nevertheless, significant morbidity persists due to associated anomalies and long-term complications such as dysmotility, strictures, and gastroesophageal reflux disease. Enhanced interdisciplinary collaboration and targeted research remain critical to further optimize management strategies and patient care.