Department of Pediatric Surgery, Children's Hospital, Helsinki, Finland.
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Eur J Pediatr Surg. 2022 Feb;32(1):56-60. doi: 10.1055/s-0041-1739422. Epub 2021 Nov 25.
To assess the risk factors for anastomotic stricture (AS) in end-to-end anastomosis (EEA) in patients with esophageal atresia (EA).
With ethical consent, hospital records of 341 EA patients from 1980 to 2020 were reviewed. Patients with less than 3 months survival ( = 30) with Gross type E EA ( = 24) and with primary reconstruction ( = 21) were excluded. Outcome measures were revisional surgery for anastomotic stricture (RSAS) and number of dilatations required for anastomotic patency without RSAS. The factors that were tested for risk of RSAS or dilatations were distal tracheoesophageal fistula (TEF) at the carina in C-type EA (congenital TEF [CTEF]), type A/B EA, antireflux surgery (ARS), anastomotic leakage, recurrent TEF, and Spitz group and congenital heart disease.
A total of 266 patients, Gross type A ( = 17), B ( = 3), C ( = 237), or D ( = 9) underwent EEA (early = 240, delayed = 26). Early anastomotic breakdown required secondary reconstruction in five patients. Of the remaining 261 patients, 17 (6.1%) had RSAS, whereas 244 patients with intact end to end required a median of five (interquartile range: 2-8) dilatations for anastomotic patency. Main risk factors for RSAS or (> 8) dilatations were CTEF, type A/B, ARS, and anastomotic leakage that increased the risk of RSAS or dilatations from 4.6- to 11-fold.
The risk of severe AS is associated with long-gap EA, significant gastroesophageal reflux, and anastomotic leakage.
评估食管闭锁（EA）患者端端吻合（EEA）吻合口狭窄（AS）的危险因素。
在获得伦理同意的情况下，回顾了 1980 年至 2020 年 341 例 EA 患者的医院记录。排除了 30 例生存时间少于 3 个月的患者、24 例 Gross 型 E EA 患者和 21 例初次重建的患者。观察指标为吻合口狭窄的再次手术（RSAS）和吻合口通畅无需 RSAS 所需的扩张次数。测试 RSAS 或扩张风险的因素包括 C 型 EA 隆突处的远端气管食管瘘（congenital TEF [CTEF]）、A型/B 型 EA、抗反流手术（ARS）、吻合口漏、复发性气管食管瘘和 Spitz 组以及先天性心脏病。
266 例患者，Gross 型 A（ = 17）、B（ = 3）、C（ = 237）或 D（ = 9）行 EEA（早期 = 240，晚期 = 26）。其余 261 例患者中，17 例（6.1%）发生 RSAS，而 244 例端端吻合完整的患者需要中位数为 5 次（四分位距：2-8）扩张以保持吻合口通畅。RSAS 或（> 8）次扩张的主要危险因素是 CTEF、A型/B 型、ARS 和吻合口漏，使 RSAS 或扩张的风险增加 4.6 至 11 倍。
长段 EA、严重胃食管反流和吻合口漏与严重 AS 风险相关。
