{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T05:34:25Z","timestamp":1778909665333,"version":"3.51.4"},"reference-count":25,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["World Jnl Ped Surgery"],"accepted":{"date-parts":[[2025,12,8]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 (\u226414 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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;\n                      <jats:italic>p<\/jats:italic>\n                      =0.020). Recovery was substantially longer for long-gap infants: median hospital stay 186\n                      <jats:italic>vs.<\/jats:italic>\n                      53 days (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001) and time to full oral feeding 209\n                      <jats:italic>vs.<\/jats:italic>\n                      29 days (p&lt;0.001). At follow-up (\n                      <jats:italic>n<\/jats:italic>\n                      =55), 34.5% required gastrostomy, 20% had feeding aversion, 36.4% experienced recurrent respiratory infections, and 10.9% had tracheomalacia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/wjps-2025-001114","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T19:00:19Z","timestamp":1767121219000},"page":"e001114","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Esophageal atresia with and without tracheoesophageal fistula: a 2016\u20132024 single-center cohort study in Saudi Arabia stratified by gap length"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5516-717X","authenticated-orcid":false,"given":"Kamal","family":"Ali","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norah S","family":"Alsabty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulrahman","family":"Altuwaym","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saud","family":"Al Jadaan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Al 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