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Anastomotic stricture following repair of esophageal atresia
S Chittmittrapap1, L Spitz, E M Kiely
1Hospital for Sick Children, London, England.
Insights
Anastomotic strictures are common after esophageal atresia repair, with braided silk sutures and reflux increasing risk. Most strictures resolve with dilation, but some require surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Esophageal atresia repair can lead to anastomotic strictures, impacting patient outcomes.
- Identifying risk factors is crucial for preventing post-operative complications.
Purpose of the Study:
- To determine the incidence of anastomotic strictures after esophageal atresia repair.
- To identify significant predisposing factors for stricture formation.
- To evaluate the effectiveness of different treatment modalities for strictures.
Main Methods:
- Retrospective analysis of 199 patients undergoing esophageal atresia repair.
- Statistical analysis to identify risk factors, including suture material, gastroesophageal reflux, and anastomotic leakage.
- Review of treatment outcomes, including dilation, resection, and antireflux surgery.
Main Results:
- Anastomotic strictures occurred in 37.2% of patients.
- Braided silk sutures, gastroesophageal reflux, and anastomotic leakage were significant predisposing factors.
- Seventy-one patients (95.9%) responded to dilation; 3 required further surgical intervention.
- Antireflux surgery was performed in 25.7% of stricture patients.
Conclusions:
- Suture material choice and management of gastroesophageal reflux are critical in preventing anastomotic strictures.
- Dilation is an effective primary treatment for most strictures.
- Early intervention is key for patients requiring surgical management.
Abstract:
Anastomotic strictures developed in 74 (37.2%) of 199 patients undergoing primary or delayed primary repair of esophageal atresia with or without tracheoesophageal fistula. Significant predisposing factors included the use of braided silk sutures (relative risk 1.72 and 1.49, compared with polyglycolic acid and polypropylene sutures), the presence of gastroesophageal reflux and leakage of the anastomosis (relative risk 2.29 and 2.04, respectively). Tracheomalacia, personnel factors, and recurrent fistula did not affect the rate of stricture formation. Seventy-one patients responded to dilatation alone, whereas three required stricture resection or esophageal substitution. All three patients requiring surgical intervention and 14 requiring five or more dilatations developed symptoms within the first 6 months after esophageal anastomosis. Antireflux surgery was carried out in 19 (25.7%) of the 74 patients.