Related Experiment Video

Updated: Jun 18, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
09:40

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

Published on: April 17, 2020

Transanastomotic Tube Use and Anastomotic Stricture: A Multicenter Prospective Randomized Trial in Neonates

Justin Lee1,2, Katie W Russell3, Caitlin Smith4

  • 1Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Annals of Surgery
|June 17, 2026
PubMed

Insights

Transanastomotic tubes (TT) did not increase anastomotic stricture (AS) risk in infants undergoing esophageal atresia repair. Surgeon-assessed anastomotic tension, not TT use, was the primary predictor of stricture development.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Clinical Trials

Background:

  • Anastomotic stricture (AS) is a common complication after esophageal atresia with distal tracheoesophageal fistula (EA/TEF) repair.
  • Previous studies suggested a potential link between transanastomotic tube (TT) use and increased AS risk, but lacked robust design.

Purpose of the Study:

  • To evaluate the impact of transanastomotic tube (TT) placement on the risk of anastomotic stricture (AS) following type C esophageal atresia with distal tracheoesophageal fistula (EA/TEF) repair.

Main Methods:

  • A multicenter randomized trial involving 142 infants undergoing type C EA/TEF repair.
  • Patients were randomized to receive either a transanastomotic tube (TT) or no TT.
  • The primary outcome was AS requiring dilation within 12 months; secondary outcomes included leak, feeding, and morbidity. Multivariable analysis was performed.

Main Results:

  • No statistically significant difference in AS rates between the TT and no TT groups (53.7% vs 47.3%, P=0.45).
  • Rates of anastomotic leak, infection, reoperation, and readmission were similar between groups.
  • Multivariable analysis indicated that TT use was not an independent predictor of AS (OR 1.18, P=0.64); however, moderate-to-severe surgeon-assessed anastomotic tension was a significant predictor (OR 2.45, P=0.026).

Conclusions:

  • Transanastomotic tube (TT) use is not associated with an increased risk of anastomotic stricture (AS) in infants undergoing repair of type C EA/TEF.
  • Intraoperative assessment of anastomotic tension by the surgeon is the most significant predictor of AS development.
  • These findings highlight the critical role of surgical judgment in minimizing stricture formation.
Abstract

Keywords:
esophageal atresiamulticenter studyneonatal surgerypediatric surgeryrandomized controlled trialsurgical outcomestracheoesophageal fistula

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