Risk factors and management for anastomotic stricture after surgical reconstruction of esophageal atresia

Abstract Aim To assess the risk factors for anastomotic stricture (AS) in end-to-end anastomosis (EEA) in patients with esophageal atresia (EA). Methods With ethical consent, hospital records of 341 EA patients from 1980 to 2020 were reviewed. Patients with less than 3 months survival (n = 30) with Gross type E EA (n = 24) and with primary reconstruction (n = 21) were excluded. Outcome measures were revisional surgery for anastomotic stricture (RSAS) and number of dilatations required for anastomotic patency without RSAS. The factors that were tested for risk of RSAS or dilatations were distal tracheoesophageal fistula (TEF) at the carina in C-type EA (congenital TEF [CTEF]), type A/B EA, antireflux surgery (ARS), anastomotic leakage, recurrent TEF, and Spitz group and congenital heart disease. Main Results A total of 266 patients, Gross type A (n = 17), B (n = 3), C (n = 237), or D (n = 9) underwent EEA (early n = 240, delayed n = 26). Early anastomotic breakdown required secondary reconstruction in five patients. Of the remaining 261 patients, 17 (6.1%) had RSAS, whereas 244 patients with intact end to end required a median of five (interquartile range: 2–8) dilatations for anastomotic patency. Main risk factors for RSAS or (> 8) dilatations were CTEF, type A/B, ARS, and anastomotic leakage that increased the risk of RSAS or dilatations from 4.6- to 11-fold. Conclusion The risk of severe AS is associated with long-gap EA, significant gastroesophageal reflux, and anastomotic leakage.

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Gender and birth weight as risk factors for anastomotic stricture after esophageal atresia repair: a systematic review and meta-analysis

BMC Pediatrics ◽

10.1186/s12887-020-02295-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Anahid Teimourian ◽

Felipe Donoso ◽

Pernilla Stenström ◽

Helena Arnadottir ◽

Einar Arnbjörnsson ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Birth Weight ◽

Esophageal Atresia ◽

Anastomotic Stricture ◽

Meta Analysis

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Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2009.11.002 ◽

2010 ◽

Vol 45 (7) ◽

pp. 1459-1462 ◽

Cited By ~ 77

Author(s):

Lydia Serhal ◽

Frédéric Gottrand ◽

Rony Sfeir ◽

Dominique Guimber ◽

Patrick Devos ◽

...

Keyword(s):

Risk Factors ◽

Esophageal Atresia ◽

Surgical Repair ◽

Anastomotic Stricture

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MP29-16 INCIDENCE AND RISK FACTORS OF URETEROENTERIC ANASTOMOTIC STRICTURE FOLLOWING RADICAL CYSTECTOMY WITH URINARY DIVERSION

The Journal of Urology ◽

10.1016/j.juro.2015.02.619 ◽

2015 ◽

Vol 193 (4S) ◽

Cited By ~ 1

Author(s):

Boyd Viers ◽

Amy Krambeck ◽

Marcelino Rivera ◽

R. Jeffrey Karnes ◽

Robert Tarrell ◽

...

Keyword(s):

Risk Factors ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Anastomotic Stricture

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EVALUATION OF RISK FACTORS AFFECTING ANASTOMOTIC LEAKAGE AFTER REPAIR OF ESOPHAGEAL ATRESIA

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202015000300003 ◽

2015 ◽

Vol 28 (3) ◽

pp. 161-162 ◽

Cited By ~ 4

Author(s):

Shahnam ASKARPOUR ◽

Mehran PEYVASTEH ◽

Hazhir JAVAHERIZADEH ◽

Nasim ASKARI

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Anastomotic Leakage ◽

Anastomotic Leak ◽

Esophageal Atresia ◽

Case Control Study ◽

Case Control ◽

Anastomotic Leaks ◽

Factors Affecting ◽

Control Study

Background: Anastomotic leak are reported among neonates who underwent esophageal atresia. Aim: To find risk factors of anastomotic leakage in patients underwent esophageal repair. Methods: All cases with esophageal atresia were included. In this case control study, patients were classified in two groups according to presence or absence of anastomotic leaks. Duration of study was 10 years. Results: Sixty-one cases were included. Mean±SD age at time of surgery in patients with leakage and without leakage was 9.50±7.25 and 8.83±6.93 respectively (p=.670). Blood transfusion and two layer anastomosis had significant correlation with anastomotic leakage. Conclusion: Blood transfusion and double layer anastomosis are associated with higher rate of anastomotic leakage.

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Incidence and risk factors for early gastrojejunostomy anastomotic stricture requiring endoscopic intervention following laparoscopic Roux-en-Y gastric bypass: a MBSAQIP analysis

Surgical Endoscopy ◽

10.1007/s00464-021-08700-x ◽

2021 ◽

Author(s):

Usah Khrucharoen ◽

Zachary N. Weitzner ◽

Yijun Chen ◽

Erik P. Dutson

Keyword(s):

Risk Factors ◽

Gastric Bypass ◽

Anastomotic Stricture ◽

Endoscopic Intervention

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Outcome of Surgery for Pediatric Gastroesophageal Reflux: Clinical and Endoscopic Follow-up after 300 Fundoplications in 279 Consecutive Patients

Scandinavian Journal of Surgery ◽

10.1177/1457496917698641 ◽

2017 ◽

Vol 107 (1) ◽

pp. 68-75 ◽

Cited By ~ 4

Author(s):

A. I. Koivusalo ◽

M. P. Pakarinen

Keyword(s):

Gastroesophageal Reflux ◽

Confidence Interval ◽

Esophageal Atresia ◽

Risk Ratio ◽

Ph Monitoring ◽

Anastomotic Stricture ◽

Symptom Control ◽

Neurological Impairment ◽

Underlying Disorder

Purpose: Clinical and endoscopic assessment of the outcome after fundoplication for pediatric gastroesophageal reflux. Basic procedures: Hospital records of 279 consecutive patients who underwent fundoplication for gastroesophageal reflux from 1991 to 2014 were reviewed. Underlying disorders, clinical and endoscopic findings, imaging studies, pH monitoring, and surgical technique were assessed. Main outcome measures were patency of fundoplication, control of symptoms and esophagitis, complications, redo operations, and predictive factors of failures. Main results: A total of 279 patients underwent 300 fundoplications (277 primaries and 23 redos). Underlying disorders in 217 (72%) patients included neurological impairment (28%) and esophageal atresia (22%). Indications for fundoplication included recalcitrant gastroesophageal reflux symptoms (44%), failure to thrive (22%), respiratory symptoms (15%), esophageal anastomotic stricture (4%), apneic spells (2%), and regurgitation (2%). Preoperative endoscopy was performed in 92% and pH monitoring in 49% of patients. Median age at primary fundoplication was 2.2 ((IQR = 0.5–7.5)) years. Fundoplication was open in 205 (74%; Nissen n = 63, Boix-Ochoa n = 97, Toupet n = 39, and other n = 6), laparoscopic in 72 (24%; Nissen n = 67 and Toupet n = 5), and included hiatoplasty in 73%. Clinical follow-up was a median of 3.9 (IQR = 1.2–9.9) years. Mortality related to surgery was 0.3%. Symptom control was achieved in 87% of patients, and esophagitis rate decreased from 65% to 29% (p < 0.001). Fundoplication failed in 41 (15%) patients. Failure was predicted by esophageal atresia risk ratio = 3.9 (95% confidence interval = 1.3–11, p = 0.01), any underlying disorder risk ratio = 3.1 (95% confidence interval = 1.1–9.1, p = 0.04), and hiatoplasty risk ratio = 2.6 (95% confidence interval = 1.1–6.6, p = 0.03). Of the 23 redo-fundoplications, 32% failed. Conclusion: The majority of patients who underwent fundoplication had an underlying disorder. Primary fundoplication provided control of symptoms in almost 90% of patients and also reduced the rate of esophagitis. Failure of primary fundoplication occurred in 15% of patients, and an underlying disorder, esophageal atresia, and hiatoplasty increased the risk of failure.

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Neurodevelopmental outcome in infants with esophageal atresia: risk factors in the first year of life

Diseases of the Esophagus ◽

10.1093/dote/doaa102 ◽

2020 ◽

Author(s):

Bevilacqua Francesca ◽

Ragni Benedetta ◽

Conforti Andrea ◽

Braguglia Annabella ◽

Gentile Simonetta ◽

...

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Cognitive Development ◽

Low Birth Weight ◽

Multiple Regression ◽

Esophageal Atresia ◽

Gestational Age ◽

Motor Development ◽

First Year ◽

First Year Of Life

Summary Data on neurodevelopmental outcomes of infants born with esophageal atresia (EA) are still scarce and controversial. The aims of our study were to evaluate motor and cognitive development during the first year of life, in patients operated on of EA and to investigate potential risk factors for motor and cognitive development both at 6 and 12 months. This is an observational prospective longitudinal study in a selected cohort of type C and D EA infants enrolled in our follow-up program from 2009 to 2017. In order to exclude possible confounding factors, the following exclusion criteria were applied: (i) gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g; (ii) genetic syndrome or chromosomal anomaly known to be associated with neurodevelopmental delay; (iii) neurologic disease; (iv) esophageal gap ≥three vertebral bodies. Patients were evaluated at 6 and 12 months of life (corrected age for infants with a gestational age of 32–37 weeks) with the Bayley Scales of Infant and Toddler Development—3rd Edition. In our selected cohort of EA infants, 82 were evaluated at 6 months and 59 were reevaluated at 12 months. Both Motor and Cognitive average scores were within the norm at both time points. However, we report increased number of infants with motor delay with time: 14% at 6 months and 24% at 12 months. Multiple regression analysis for Motor scores at 6 [F(4,74) = 4.363, P = 0.003] and 12 months [F(6,50) = 2.634, P = 0.027] identified (i) low birth weight, (ii) longer hospital stay and (iii) weight < fifth percentile at 1 year as risk factors. Interestingly, average Cognitive scores also increased with time from 85.2% at 6 months and 96.6% at 12 months. Multiple regression models explaining variance of Cognitive scores at 6 [F(4, 73) = 2.458, P = 0.053] and 12 months [F(6, 49) = 1.232, P = 0.306] were nonsignificant. Our selected cohort of EA patients shows, on the average, Motor and Cognitive scores within the norm both at 6 and 12 months. Nevertheless, the percentage of infants with Motor scores below the average increases regardless gestational age. None of clinical and sociodemographic variables taken into consideration was able to predict cognitive development both at 6 and 12 months whereas risk factors for Motor development change during the first year of life. Healthcare providers should pay particular attention to patients with low birth weight, longer hospital stays and weight under fifth percentile at 1 year. Future studies should include long-term outcomes to reveal possible catch up in motor development and/or possible findings in Cognitive scores.

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