Comparative Analysis of Postoperative Outcomes and Complications of One-Stage Versus Staged Surgical Repair in Esophageal Atresia: A Retrospective Study from a Tertiary Pediatric Center

Background Esophageal atresia (EA) is a complex congenital anomaly requiring prompt surgical correction in neonates. The optimal approach between primary (one-stage) and staged (multi-stage) repair remains debated, especially in infants with comorbidities or long-gap defects. To compare postoperative outcomes and complications of one-stage versus staged surgical repair for EA in a tertiary pediatric center in Iran. Methods In this retrospective study, medical records of 115 neonates with EA treated between 2017 and 2024 at Motahari Pediatric Hospital were reviewed. Demographic features, associated anomalies, perioperative and postoperative complications, surgical duration, hospital stay, and survival rates were compared between the one-stage and two-stage repair groups using appropriate statistical tests. Results Of the 115 patients, 68 underwent primary repair and 47 staged repair. No significant differences were observed in postoperative complications, mortality, or hospital stay between the groups (p > 0.05). The mean operative time and hospitalization were longer in the two-stage group, but these differences did not reach statistical significance. Linear regression showed no significant association between chronological age and operative duration (B=-0.026, p = 0.570), nor between birth weight and operative duration (r=-0.040, p = 0.672). However, a significant inverse correlation between gestational age and surgical duration was observed (Spearman’s rho=-0.225, p = 0.016), suggesting that higher gestational age may be associated with shorter operative times. Conclusion One-stage and staged repairs provide comparable short-term outcomes in neonates with EA, supporting individualized surgical planning based on patient factors. The association between gestational age and operative duration warrants further investigation in prospective multicenter studies to optimize surgical decision-making and improve long-term results.