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

Floor W. T. Vergouwe, John 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, René M. H. Wijnen

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Abstract

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
Early online date14 Jul 2018
DOIs
Publication statusPublished - 1 Feb 2019

Cite this

Vergouwe, F. W. T., 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. (2019). Risk factors for refractory anastomotic strictures after oesophageal atresia repair: A multicentre study. Archives of Disease in Childhood, 104(2), 152-157. https://doi.org/10.1136/archdischild-2017-314710