Anastomotic Stricture in End-to-End Anastomosis—Risk Factors in a Series of 261 Patients with 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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Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314710 ◽

2018 ◽

Vol 104 (2) ◽

pp. 152-157 ◽

Cited By ~ 10

Author(s):

Floor W T Vergouwe ◽

John Vlot ◽

Hanneke IJsselstijn ◽

Manon C W Spaander ◽

Joost van Rosmalen ◽

...

Keyword(s):

Risk Factors ◽

Multicentre Study ◽

Anastomotic Leakage ◽

Oesophageal Atresia ◽

Anastomotic Stricture ◽

Multivariable Logistic Regression Analysis ◽

Exclusion Criteria ◽

Anastomotic Strictures ◽

End To End

ObjectiveTo determine the incidence of refractory anastomotic strictures after oesophageal atresia (OA) repair and to identify risk factors associated with refractory strictures.MethodsRetrospective national multicentre study in patients with OA born between 1999 and 2013. Exclusion criteria were isolated fistula, inability to obtain oesophageal continuity, death prior to discharge and follow-up <6 months. A refractory oesophageal stricture was defined as an anastomotic stricture requiring ≥5 dilations at maximally 4-week intervals. Risk factors for development of refractory anastomotic strictures after OA repair were identified with multivariable logistic regression analysis.ResultsWe included 454 children (61% male, 7% isolated OA (Gross type A)). End-to-end anastomosis was performed in 436 (96%) children. Anastomotic leakage occurred in 13%. Fifty-eight per cent of children with an end-to-end anastomosis developed an anastomotic stricture, requiring a median of 3 (range 1–34) dilations. Refractory strictures were found in 32/436 (7%) children and required a median of 10 (range 5–34) dilations. Isolated OA (OR 5.7; p=0.012), anastomotic leakage (OR 5.0; p=0.001) and the need for oesophageal dilation ≤28 days after anastomosis (OR 15.9; p<0.001) were risk factors for development of a refractory stricture.ConclusionsThe incidence of refractory strictures of the end-to-end anastomosis in children treated for OA was 7%. Risk factors were isolated OA, anastomotic leakage and the need for oesophageal dilation less than 1 month after OA repair.

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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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Clinical Comparison Between Thoracoscopic and Thoracotomy Repair of Gross Type C Esophageal Atresia

10.21203/rs.3.rs-515023/v1 ◽

2021 ◽

Author(s):

Shen Yang ◽

Peize Wang ◽

Zhi Yang ◽

Siqi Li ◽

Junmin Liao ◽

...

Keyword(s):

Postoperative Complications ◽

Anastomotic Leakage ◽

Esophageal Atresia ◽

Tracheoesophageal Fistula ◽

Operative Time ◽

Anastomotic Stricture ◽

Surgical Approaches ◽

Invasive Technique ◽

Thoracoscopic Approach ◽

Type C

Abstract Background To compare the clinical outcomes between thoracoscopic approach and thoracotomy surgery in patients with Gross type C Esophageal atresia (EA) and tracheoesophageal fistula (TEF). Methods Patients with Gross type C EA/TEF who underwent surgery from January 2007 to January 2020 at Beijing Children’s Hospital were retrospectively analyzed. The patients were divided into 2 groups according to surgical approaches. The perioperative factors and postoperative complications were compared among the 2 groups. Results One hundred and ninety patients (132 boys and 58 girls) with a median birth weight of 2975 (2600, 3200) g were included. The primary operations were performed via thoracoscopic (n = 62) and thoracotomy (n = 128) approach. After comparison of clinical characteristics between the 2 groups, we found that there were statistically significant differences in associated anomalies, method of fistula closure, duration of mechanical ventilation after surgery, feeding option before discharge, management of pneumothorax, and prognosis (all P < 0.05). To a certain extent, thoracoscopic surgery reduced the incidence of anastomotic leakage and increased the incidence of anastomotic stricture in this study. However, there were no statistically significant differences between the 2 groups in terms of operative time, postoperative pneumothorax, anastomotic leakage, anastomotic stricture, and recurrent tracheoesophageal fistula (all P > 0.05). Conclusions Thoracoscopy surgery for Gross type C EA/TEF is a safe and effective, minimally invasive technique with comparable operative time and incidence of postoperative complications.

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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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Nomogram for Benign Anastomotic Stricture After Surgery for Colorectal Cancer

10.21203/rs.3.rs-581163/v1 ◽

2021 ◽

Author(s):

Xuhua Hu ◽

Peiyuan Guo ◽

Ning Zhang ◽

Ganlin Guo ◽

Baokun Li ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Predictive Model ◽

Anastomotic Leakage ◽

Anastomotic Stricture ◽

Small Sample ◽

Anal Margin ◽

Anastomotic Site ◽

Tertiary Center ◽

Protective Stoma

Abstract Background Benign anastomotic stricture remains among the most prevalent complications following surgery for colorectal cancer, albeit its incidence is very low. Objective This study is aimed at identifying risk factors of anastomotic stricture as well as generating an effective nomogram for the stricture. Design: This is a retrospective study. Setting: This study was conducted from January, 2015 to December, 2019 in a single tertiary center with colorectal cancer. Patients: A total of 117 colorectal patients after surgery without recurrence including 39 with anastomotic stricture (the distance between anastomotic site and anal margin < = 20 cm) and 78 without the stricture were enrolled in this study. Main outcome measures: Their clinical and pathological data were collected. Multiple logistic regression analysis was conducted for identifying risk factors for anastomotic stricture, and the nomogram prediction model was generated. Results Multivariate analysis of the primary cohort led to identification of LCA (left colon artery) preservation (OR, 0.074; P = 0.0015), protective stoma (OR, 5.353; P = 0.012), anastomotic leakage (OR, 12.027; P = 0.005), and anastomotic distance (OR, 7.578; P = 0.012) as independent risk factors for anastomotic stricture. The following predictive model was derived: Logit (anastomotic stricture) = 0.074* LCA + 5.353* Protective stoma + 12.027* Anastomotic leakage + 7.578* Anastomotic distance. Assessment of the predictive model revealed that the area under curve (AUC) was 0.871, while the cutoff value was 15.444, with a sensitivity of 64.1% and a specificity of 94.8%. Limitations: A retrospective and case-controlled design with a small sample size from one single center is the main Limitation. Conclusions LCA preservation, protective stoma, anastomotic leakage, and anastomotic distance may affect the occurrence of anastomotic stricture following surgery for colorectal cancer. The nomogram model generated in the present study can be valuable in prediction of anastomotic stricture. Registered at Chinese Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR 2100043775).

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Outcome of thoracoscopic repair of type-C esophageal atresia: a single-center experience from North Africa

Diseases of the Esophagus ◽

10.1093/dote/doaa001 ◽

2020 ◽

Vol 33 (7) ◽

Cited By ~ 1

Author(s):

Mohamed M Elbarbary ◽

Aly Shalaby ◽

Mohamed Elseoudi ◽

Hamed M Seleim ◽

Moutaz Ragab ◽

...

Keyword(s):

Minimally Invasive ◽

Anastomotic Leakage ◽

Esophageal Atresia ◽

Operative Time ◽

Anastomotic Stricture ◽

Primary Anastomosis ◽

Tertiary Care ◽

Thoracoscopic Approach ◽

Thoracoscopic Repair ◽

Type C

Summary Thoracoscopic repair of esophageal atresia is gaining popularity worldwide attributable to availability and advances in minimally invasive instruments. In this report, we presented our experience with thoracoscopic esophageal atresia/tracheoesophageal fistula (EA/TEF) repair in our tertiary care institute. A prospective study on short-gap type-C EA/TEF was conducted at Cairo University Specialized Pediatric Hospital between April 2016 and 2018. Excluded were cases with birth weight < 1500 gm, inability to stabilize physiologic parameters, or major cardiac anomalies. The technique was standardized in all cases and was carried out by operating team concerned with minimally invasive surgery at our facility. Primary outcome evaluated was successful primary anastomosis. Secondary outcomes included operative time, conversion rate, anastomotic leakage, recurrent fistula, postoperative stricture, and time till discharge. Over the inclusion period of this study, 136 cases of EA/TEF were admitted at our surgical NICU. Thoracoscopic repair was attempted in 76 cases. In total, 30 cases were pure atresia/long gap type-C atresia and were excluded from the study. Remaining 46 cases met the inclusion criteria and were enrolled in the study. Mean age at operation was 8.7 days (range 2–32), and mean weight was 2.6 Kg (range 1.8–3.6). Apart from five cases (10.8%) converted to thoracotomy, the mean operative time was 108.3 minutes (range 80–122 minute). A tension-free primary anastomosis was possible in all thoracoscopically managed cases (n = 41) cases. Survival rate was 85.4% (n = 35). Anastomotic leakage occurred in seven patients (17%). Conservative management was successful in two cases, while esophagostomy and gastrostomy were judged necessary in the other for five. Anastomotic stricture developed in five cases (16.6%) of the 30 surviving patients who kept their native esophagus. Despite the fact that good mid-term presented results may be due to patient selection bias, thoracoscopic approach proved to be feasible for management of short-gap EA/TEF. Authors of this report believe that thoracoscopy should gain wider acceptance and pediatric surgeons should strive to adopt this procedure.

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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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DOZ047.89: Thoracoscopic (TS) management of early complications after esophageal atresia (EA) correction: single center experience

Diseases of the Esophagus ◽

10.1093/dote/doz047.89 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

M Andreetta ◽

M Erculiani ◽

F F Leon ◽

P Gamba

Keyword(s):

Anastomotic Leakage ◽

Esophageal Atresia ◽

Open Surgery ◽

Anastomotic Stricture ◽

Case Reports ◽

Azygos Vein ◽

Oral Feeding ◽

Conservative Approach ◽

Early Complications ◽

First Choice

Abstract Background Early complications and their surgical management after esophageal atresia (EA) correction aren’t largely described in the literature. Anastomotic stricture and anastomotic leakage are the most commonly described. Those, along with iatrogenic chylothorax, are safely managed with a conservative approach. Surgery is indicated for nonresponding cases and often carries major invasiveness. This study reports thoracoscopy use for EA complications at our center in a 2-year period (2017–2018). Case Reports Case 1, birth weight (BW) 1550 gr, presented respiratory difficulties 6 days after open surgery: chest X-ray revealed right diaphragmatic eventration probably due to phrenic nerve damage; Case 2 (BW 3420 gr) presented anastomotic dehiscence with salivary traces in drainage tube, 9 days after thoracoscopic (TS) repair with azygos vein sparing; Case 3 (BW 2530 gr) developed right chylothorax 13 days after right thoracotomy following primary TS left approach for dextrocardia (5 days after oral feeding was started) resistant to Octreotide treatment. All cases were successfully treated with TS technique. Case 1 underwent TS right diaphragmatic plication after an initial conservative approach. In case 2 we performed TS anastomosis revision with bovine pericardium patch apposition. Case 3 underwent right TS cruentation and glueing of the right costophrenic recess (6 weeks after surgery) for chylothorax persistence despite 22 days of Octreotide therapy. No intra- or postoperative complication occurred. A TS approach for EA repair is replacing open surgery, which is nowadays limited to selected neonates. The open technique seems to increase the risk of postoperative early complications, probably because thoracoscopy allows optimal anatomy visualization and minimal tissue handling. It is also postulated that TS azygos sparing may be a preventive factor against anastomotic leakage, even though it can be technically demanding. Furthermore, thoracoscopy can reduce invasiveness in the case of a diagnostic maneuver such as left anatomy exploration. Conclusions Early surgical complications after EA repair are rare, and can be safely treated with a TS approach, regardless of the primary surgical technique. If properly managed, they have good prognosis. Benefits of TS EA repair are widely known, and early reintervention for complications with this technique seems to be safe and justified in centers where neonatal MIS is the –first-choice approach.

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Clinical comparison between thoracoscopic and thoracotomy repair of Gross type C esophageal atresia

BMC Surgery ◽

10.1186/s12893-021-01360-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shen Yang ◽

Peize Wang ◽

Zhi Yang ◽

Siqi Li ◽

Junmin Liao ◽

...

Keyword(s):

Postoperative Complications ◽

Anastomotic Leakage ◽

Esophageal Atresia ◽

Tracheoesophageal Fistula ◽

Operative Time ◽

Anastomotic Stricture ◽

Surgical Approaches ◽

Invasive Technique ◽

Thoracoscopic Approach ◽

Type C

Abstract Background To compare the clinical outcomes between thoracoscopic approach and thoracotomy surgery in patients with Gross type C Esophageal atresia (EA) and tracheoesophageal fistula (TEF). Methods Patients with Gross type C EA/TEF who underwent surgery from January 2007 to January 2020 at Beijing Children’s Hospital were retrospectively analyzed. The patients were divided into two groups according to surgical approaches. The perioperative factors and postoperative complications were compared among the two groups. Results One hundred and ninety patients (132 boys and 58 girls) with a median birth weight of 2975 (2600, 3200) g were included. The primary operations were performed via thoracoscopic (n = 62) and thoracotomy (n = 128) approach. After comparison of clinical characteristics between the two groups, we found that there were statistically significant differences in associated anomalies, method of fistula closure, duration of mechanical ventilation after surgery, feeding option before discharge, management of pneumothorax, and prognosis (all P < 0.05). To a certain extent, thoracoscopic surgery reduced the incidence of anastomotic leakage and increased the incidence of anastomotic stricture in this study. However, there were no statistically significant differences between the two groups in terms of operative time, postoperative pneumothorax, anastomotic leakage, anastomotic stricture, and recurrent tracheoesophageal fistula (all P > 0.05). Conclusions Thoracoscopy surgery for Gross type C EA/TEF is a safe and effective, minimally invasive technique with comparable operative time and incidence of postoperative complications.

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