{
  "abstract": "Objective To describe phenotype, perioperative events, and early morbidity among infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF), and to evaluate how gap length relates to postoperative and follow-up outcomes.Methods A retrospective single-center cohort study was conducted in a tertiary neonatal and pediatric surgery service, Riyadh, Saudi Arabia. All infants with EA/TEF managed between January 1, 2016 and December 31, 2024. Clinical data include early clinical anastomotic leak (≤14 days), recurrent fistula, anastomotic stricture and time-to-event outcomes including hospital length of stay, time to full oral feeding, duration of postoperative ventilation and duration of parenteral nutrition. Follow-up outcomes included respiratory morbidity and feeding support requirements.Results Sixty-seven infants were included; gross type C was most frequent (73.1%). Gap length was assessable in 63 non-H-type cases, with 31.7% classified as long-gap EA. Survival to discharge was 86% after excluding three trisomy 18 infants managed palliatively. Primary repair was achieved in 67.2% overall but in only 10% of long-gap infants, among whom staged repair or gastric pull-up predominated. Early anastomotic leak occurred in 26.9%, recurrent fistula in 14.9% and anastomotic stricture in 32.8%. In multivariable logistic regression, long-gap EA was the only independent predictor of stricture (adjusted odds ratio (OR) 4.44; 95% confidence interval (CI) 1.27 to 15.55; p=0.020). Recovery was substantially longer for long-gap infants: median hospital stay 186 vs. 53 days (p<0.001) and time to full oral feeding 209 vs. 29 days (p<0.001). At follow-up (n=55), 34.5% required gastrostomy, 20% had feeding aversion, 36.4% experienced recurrent respiratory infections, and 10.9% had tracheomalacia.Conclusions Gap length was the principal determinant of anastomotic stricture and prolonged recovery after EA/TEF repair. These data provide a baseline for ongoing quality improvement and support early referral of long-gap cases to specialized multidisciplinary centers with structured follow-up programs.",
  "authors": [
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia",
        "King Saud bin Abdulaziz University for Health Sciences, Riyadh, Riyadh Province, Saudi Arabia"
      ],
      "name": "Kamal Ali"
    },
    {
      "affiliations": [
        "Department of Pediatric Surgery, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia"
      ],
      "name": "Norah S Alsabty"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Abdulrahman Altuwaym"
    },
    {
      "affiliations": [
        "King Saud bin Abdulaziz University for Health Sciences, Riyadh, Riyadh Province, Saudi Arabia",
        "Department of Pediatric Surgery, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia"
      ],
      "name": "Saud Al Jadaan"
    },
    {
      "affiliations": [
        "King Saud bin Abdulaziz University for Health Sciences, Riyadh, Riyadh Province, Saudi Arabia",
        "Department of Pediatric Surgery, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia"
      ],
      "name": "Mohammed Al Namshan"
    },
    {
      "affiliations": [
        "Department of Pediatric Surgery, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia"
      ],
      "name": "Nawaf Alharbi"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Saud bin Abdulaziz University for Health Sciences, Riyadh, Riyadh Province, Saudi Arabia"
      ],
      "name": "Abdulaziz Homedi"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Saud bin Abdulaziz University for Health Sciences, Riyadh, Riyadh Province, Saudi Arabia"
      ],
      "name": "Ibrahim Ali"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia",
        "King Saud bin Abdulaziz University for Health Sciences, Riyadh, Riyadh Province, Saudi Arabia"
      ],
      "name": "Saif Alsaif"
    }
  ],
  "title": "Esophageal atresia with and without tracheoesophageal fistula: a 2016–2024 single-center cohort study in Saudi Arabia stratified by gap length",
  "uid": "9816a80e-8604-5104-8611-fa3ff508b1e5"
}