TY - JOUR
T1 - Risk factors for refractory anastomotic strictures after oesophageal atresia repair: A multicentre study
AU - Vergouwe, Floor W. T.
AU - Vlot, John
AU - Ijsselstijn, Hanneke
AU - Spaander, Manon C. W.
AU - van Rosmalen, Joost
AU - Oomen, Matthijs W. N.
AU - Hulscher, Jan B. F.
AU - Dirix, Marc
AU - Bruno, Marco J.
AU - Schurink, Maarten
AU - Wijnen, René M. H.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Objective: To determine the incidence of refractory anastomotic strictures after oesophageal atresia (OA) repair and to identify risk factors associated with refractory strictures. Methods: Retrospective 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. Results: We 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. Conclusions: The 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.
AB - Objective: To determine the incidence of refractory anastomotic strictures after oesophageal atresia (OA) repair and to identify risk factors associated with refractory strictures. Methods: Retrospective 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. Results: We 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. Conclusions: The 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.
KW - oesophageal atresia
KW - oesophageal dilation procedures
KW - oesophageal strictures
KW - outcome
KW - risk factors
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85050191523&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30007949
U2 - https://doi.org/10.1136/archdischild-2017-314710
DO - https://doi.org/10.1136/archdischild-2017-314710
M3 - Article
C2 - 30007949
SN - 0003-9888
VL - 104
SP - 152
EP - 157
JO - Archives of disease in childhood
JF - Archives of disease in childhood
IS - 2
ER -