Early Versus Delayed Surgical Repair in Neonates with Esophageal Atresia: A Systematic Review of Long-Term Survival and Complications
DOI:
https://doi.org/10.56294/saludcyt20251648Keywords:
Esophageal atresia, neonatal surgery, early repair, delayed repair, long-term survival, complications, anastomotic strictures, gastroesophageal reflux, recurrent fistulas, feeding difficulties, vacterl association, congenital anomalies, neonatal outcomesAbstract
This systematic review is aimed to explore long-term survival and complications associated with early versus delayed surgical repair in neonates with long-gap esophageal atresia (LGEA).Through analysis of studies published from 2012-2025 was conducted and we collected data from 7 papers, with long-term follow-up, up to one year. Delayed primary anastomosis (DPA) was most frequently employed intervention with mean repair timing of 11.9 weeks. Results indicate that over 90% of patients achieved functional esophageal continuity with the majority able to eat without swallowing difficulties. Gastroesophageal reflux (GER) was prevalent complication which was affecting 30%–40.8% of cases with strictures occurring in 53.7%–60% of patients and statistically significant association with anastomotic leaks (p < 0.0001). Dysphagia was also linked to GER (p = 0.0174) and need long-term monitoring and management. Early surgical repair while reducing the duration of preoperative interventions, demonstrated a higher incidence of anastomotic leaks (22.7%–30%) and strictures increasing need for subsequent dilations or surgical revisions. All the evidences that we reported find delayed repair as a feasible approach with favorable long-term outcomes like high esophageal preservation rates and reduced early postoperative complications. Patient selection and institutional expertise play critical roles in optimizing surgical outcomes and study limitations include heterogeneity in study designs or large variations of follow-up durations and outcome definitions. Further prospective studies can establish standardized treatment protocols which can minimize complications which are associated with both early and delayed approaches.
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Copyright (c) 2025 Javier Alejandro Navarro Acevedo , Yalisa Consuegra Montes , Dyrla Jhoesmy Maturana Leudo, Luisa María Mosquera Gil, Andrea Carolina Muhamad Saldaña (Author)
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