Impact of Muscle Paralysis After Primary Esophageal Atresia Repair

Background: Post-operative muscle paralysis aims to reduce anastomotic complications following primary esophageal atresia (EA) repair. This study evaluates the impact of paralysis on outcomes in children enrolled in the EUPSA Esophageal Atresia Registry (EAR). Methods: Patients with type B, C, and D EA enrolled in the EAR between 2014 and 2017 who underwent primary EA repair were included. They were divided into two groups based on the use of paralysis (Group P) or not (Group NP). Comparisons included demographics, associated malformations, surgical approach, complications, and hospital stay. Multivariate logistic regressions analyses were performed. Results: Of 316 patients, 126 were in Group P and 190 in Group NP. Group P had significantly lower gestational age and birth weight. Ventilation duration (7.9 ± 10.4 vs. 4.0 ± 4.4 days; p < 0.001) and hospital stay (43.7 ± 93.7 vs. 27.5 ± 31.8 days; p < 0.001) were significantly longer in Group P. The overall complication rate was higher in Group P (39.7 % vs. 28.4 %; p = 0.036), but mortality rates did not differ significantly. Post-operative paralysis was not associated with a significant reduction in anastomotic leaks or strictures. Conclusions: Post-operative paralysis may provide stability in high-risk cases, such as neonates with low birth weight or associated malformations, but it does not significantly reduce surgical complications and may prolong recovery. Its use should be carefully considered and limited to individualized scenarios where the benefits outweigh the risks.