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Impact of Muscle Paralysis After Primary Esophageal Atresia Repair

Federica Pederiva1, Tutku Soyer2, Paolo Dalena3

  • 1Pediatric Surgery, "F. Del Ponte" Hospital, ASST Settelaghi, Varese, Italy.

Journal of Pediatric Surgery
|May 10, 2025
PubMed

Insights

Post-operative muscle paralysis in esophageal atresia repair did not reduce complications and prolonged hospital stays. Its use in neonates should be individualized, considering potential risks and benefits.

Area of Science:

  • Pediatric Surgery
  • Neonatal Care
  • Surgical Complications

Background:

  • Post-operative muscle paralysis is employed to minimize anastomotic complications in primary esophageal atresia (EA) repair.
  • The EUPSA Esophageal Atresia Registry (EAR) database was utilized to assess the impact of paralysis on patient outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of post-operative muscle paralysis in reducing complications after primary EA repair.
  • To analyze the influence of paralysis on recovery time and overall outcomes in pediatric EA patients.

Main Methods:

  • A cohort of 316 patients with type B, C, and D EA undergoing primary repair (2014-2017) was analyzed.
  • Patients were stratified into two groups: those receiving post-operative paralysis (Group P) and those not (Group NP).
  • Demographics, associated malformations, surgical approach, complications, and hospital stay were compared using multivariate logistic regression.

Main Results:

  • Group P (n=126) had lower gestational age and birth weight compared to Group NP (n=190).
  • Group P experienced significantly longer ventilation duration (7.9 vs. 4.0 days) and hospital stay (43.7 vs. 27.5 days).
  • Overall complication rates were higher in Group P (39.7% vs. 28.4%), with no significant difference in mortality, anastomotic leaks, or strictures.

Conclusions:

  • Post-operative paralysis did not significantly decrease surgical complications in EA repair.
  • While potentially offering stability in high-risk neonates, paralysis may prolong recovery and increase overall complications.
  • The use of post-operative paralysis should be carefully considered and reserved for individualized cases where benefits are anticipated to outweigh risks.
Abstract

Keywords:
Esophageal atresiaMuscle paralysisOutcomePrimary repair

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