Risk factors for reoperation and treatment strategies following repair of esophageal atresia

Purpose Reoperation is frequently necessary after primary repair of esophageal atresia (EA). This study aimed to identify risk factors for reoperation and propose a perioperative management strategy. Methods A retrospective review was conducted on 42 EA patients treated at our institution between 2008 and 2024. Patients were divided into two groups based on whether reoperation was required, and statistical analysis was used to identify risk factors. Results Of the 42 patients, 34 underwent primary repair. The median birth weight was 2418 g (range: 1828–3349). Gross type A was found in 4 patients and type C in 30. Ten patients developed recurrent tracheoesophageal fistula (rTEF) or anastomotic leak; 6 required reoperations. Among these, 5 were female, and the median gap length was 1.7 cm. Two patients had staged repairs and had gastroesophageal reflux. Reoperations included re-anastomosis (n = 2), rTEF division (n = 2), and both procedures (n = 2). One patient required a third surgery due to a second rTEF. The reoperation group had higher rates of female sex, lower birth weight, rTEF, longer hospital stays, and neurodevelopmental delay ( p  < 0.01). Conclusion Low birth weight and rTEF are key risk factors for reoperation. Individualized surgical planning and complication management are essential to reduce repeat surgeries. Level of evidence: Level II Retrospective Study.