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Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study

Vergouwe, FWT., Vlot, J., Ijsselstijn, H., Spaander, M. C. W., van Rosmalen, J., Oomen, M. W. N., Hulscher, J. B. F., Dirix, M., Bruno, M. J., Schurink, M. & Wijnen, R. M. H., Jan-2019, In : Archives of Disease in Childhood. 104, 2, p. 152-157 6 p.

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  • Risk factors for refractory anastomotic strictures after oesophageal atresia repair

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DOI

  • FWT Vergouwe
  • J Vlot
  • Hanneke Ijsselstijn
  • Manon C. W. Spaander
  • Joost van Rosmalen
  • Matthijs W N Oomen
  • Jan B.F. Hulscher
  • Marc Dirix
  • Marco J. Bruno
  • Maarten Schurink
  • Rene M. H. Wijnen
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.
Original languageEnglish
Pages (from-to)152-157
Number of pages6
JournalArchives of Disease in Childhood
Volume104
Issue number2
Publication statusPublished - Jan-2019

    Keywords

  • oesophageal atresia, MORTALITY, ANOMALIES, PROTON PUMP INHIBITORS, TRACHEOESOPHAGEAL FISTULA, THORACOSCOPIC REPAIR, SURGICAL REPAIR, COMPLICATIONS, CHILDREN, MORBIDITY, FREQUENCY

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