Comparative Study of Extrapleural and Transpleural Approaches for Infant Esophageal Atresia

Background and Aim: Type III esophageal atresia is one of the most common congenital anomalies of the upper gastrointestinal tract, often associated with tracheoesophageal fistula, requiring urgent neonatal surgery. The optimal surgical approach, including extrapleural or transpleural repair, remains controversial and can affect postoperative complications and clinical outcomes. This study aimed to compare the outcomes of extrapleural and transpleural surgery in patients with type III esophageal atresia. Materials and Methods: This retrospective cohort study included ۵۰ neonates who underwent surgical repair between ۲۰۱۲ and ۲۰۲۲. Patients were divided into extrapleural (n=۲۶) and transpleural (n=۲۴) groups. Demographic data, birth weight, age at surgery, postoperative complications, anastomotic leakage, pneumothorax, recurrence, length of hospital stay, and mortality were collected and analyzed. Chi-square and independent t-tests were used for statistical comparisons. Results: No significant differences in birth weight or age at surgery were observed between the groups. Anastomotic leakage occurred in ۳.۸% of the extrapleural group and ۱۲.۵% of the transpleural group (P=۰.۲۶۰). Pneumothorax and recurrence rates were lower in the extrapleural group, but differences were not statistically significant. Mean length of hospital stay and mortality were also similar between groups. Conclusion: Both extrapleural and transpleural approaches are safe and effective for repairing type III esophageal atresia, although the extrapleural surgery is associated with fewer short-term complications. Selection of the surgical approach should consider the surgeon’s experience, patient clinical condition, and anatomical features. Further prospective studies with larger sample sizes are recommended to determine the superior approach and assess long-term outcomes.

کلیدواژه ها:

Esophageal atresia ، Extrapleural ، Transpleural ، Anastomotic leakage ، Neonatal surgery