Long-term impact of anastomotic leakage following esophageal atresia repair: feeding outcomes, esophageal morbidity, and reinterventions.

PURPOSE: Anastomotic leakage remains one of the most common complications after esophageal atresia (EA) repair. However, its impact on long-term esophageal morbidity and functional outcomes remains incompletely understood. This study evaluated the clinical consequences of postoperative anastomotic leakage following EA repair.

METHODS

We retrospectively reviewed patients with EA who underwent surgical repair at a single tertiary center between 2010 and 2024. Patients with type E EA were excluded. Clinical characteristics, operative variables, postoperative complications, feeding outcomes, and long-term esophageal morbidities were compared according to the presence of anastomotic leakage. Multivariable logistic regression analyses were performed to identify factors associated with anastomotic stricture and gastroesophageal reflux disease (GERD).

RESULTS

A total of 143 patients were included, of whom 36 (25.2%) developed anastomotic leakage. Patients with leakage had a higher incidence of anastomotic stricture than those without leakage (78% vs. 57%, p = 0.029). Leakage was also associated with delayed feeding progression, 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 were more frequent in the leakage group (31% vs. 11%, p = 0.008). In multivariable analysis, greater gap distance was independently associated with an increased risk of anastomotic stricture (adjusted OR 1.38, 95% CI 1.05-1.87, p = 0.026), whereas anastomotic leakage remained associated with GERD after adjustment for the available covariates (adjusted OR 2.60, 95% CI 1.14-6.26, p = 0.027).

CONCLUSION

Anastomotic leakage after EA repair is associated with delayed feeding progression, increased esophageal morbidity, and a higher risk of unplanned reoperation. In addition, anastomotic leakage remained associated with GERD after adjustment for the available covariates. These findings suggest that patients who experience postoperative leakage represent a high-risk group that may benefit from careful long-term surveillance and multidisciplinary follow-up.