Defining an Anastomotic Stricture Following Oesophageal Atresia Repair

Babies who have undergone repair of an oesophageal atresia may have the anastomosis dilated, often more than once. The number of times a baby undergoes anastomotic dilatation therefore forms a discrete random variable. The aim of this study is to characterise the probability distribution of this variable to determine the probabilities of dilatation for the population of babies with oesophageal atresia. Secondly we suggest a possible definition of an anastomotic stricture.

The dilatations performed on a consecutive institutional series were recorded. The dataset was fitted to the Poisson and negative binomial probability distributions, calculating the parameters with maximum likelihood estimators, then calculating the probabilities of the number of dilatations and the quantiles. We also collected the following clinical variables: whether the atresia was complex, the occurrence of an anastomotic leak, the need for salvage surgery and subsequent resection of the anastomosis, fundoplication surgery, karyotype status, cardiac status and neurological status.

The sample was right skewed and fitted the negative binomial, but not the Poisson distribution, well. The parameters of the distribution are: μˆ: 4.41, kˆ: 0.56. The quantiles and calculation of specific probabilities are presented. The 0.9 quantile is 12 dilatations; this was strongly associated with both the use of salvage surgery (OR = 4.686 (1.105, 17.697), and the need for resection of the anastomosis (OR = 23.366 (3.013, 281.822), p = 0.001) and fundoplication (OR = 7.55 (2.17,30.31, p = 0.0004)), suggesting construct validity. Using this definition, our institutional stricture rate is 9 %.

Identifying that the number of dilatations fits a negative binomial distribution allows us to use statistical inference to state probabilities not of our sample, but of the underlying population of babies with this condition, assuming the distribution is confirmed to fit other such samples. We suggest the 0.9 quantile of 12 dilatations could form a definition of a stricture.