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Eur J Pediatr Surg 2024; 34(06): 550-557
DOI: 10.1055/a-2340-9078
Original Article

Determining the Risk Factors for Anastomotic Stricture Development after Esophageal Atresia Repair: Results from the Turkish Esophageal Atresia Registry

Can İhsan Öztorun 
1   Department of Pediatric Surgery, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
,
Çiğdem Ulukaya Durakbaşa
2   Department of Pediatric Surgery, Faculty of Medicine, Istanbul Medeniyet University, İstanbul, Turkey
,
Tutku Soyer 
3   Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
,
Coşkun Özcan
4   Department of Pediatric Surgery, Faculty of Medicine, Ege University, İzmir, Turkey
,
Binali Fırıncı
5   Department of Pediatric Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
,
Berat Dilek Demirel
6   Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
,
İlhan Çiftçi
7   Department of Pediatric Surgery, Faculty of Medicine, Selçuk University, Konya, Turkey
,
Ayşe Parlak
8   Department of Pediatric Surgery, Faculty of Medicine, Uludağ University, Bursa, Turkey
,
Mustafa Onur Öztan 
9   Department of Pediatric Surgery, Faculty of Medicine, Izmir Katip Celebi University, İzmir, Turkey
,
Gülnur Göllü Bahadır
10   Department of Pediatric Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
,
İbrahim Akkoyun
11   Department of Pediatric Surgery, Konya Education and Research Hospital, Konya, Turkey
,
Ayşe Karaman
12   Department of Pediatric Surgery, University of Health Sciences Turkey, Ankara Dr Sami Ulus Children's Hospital, Ankara, Turkey
,
Cengiz Gül
13   Department of Pediatric Surgery, University of Health Sciences Turkey, Zeynep Kamil Maternity and Children Health and Research Application Center, İstanbul, Turkey
,
Gül Şalcı
14   Department of Pediatric Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
,
Hüseyin İlhan
15   Department of Pediatric Surgery, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir Turkey
,
Akgün Oral 
16   Department of Pediatric Surgery, Dr. Behcet Uz Education and Research Hospital, Izmir, Turkey
,
Rahşan Özcan
17   Department of Pediatric Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
,
Seyithan Özaydın
18   Department of Pediatric Surgery, University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
,
Şeref Selçuk Kılıç
19   Department of Pediatric Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
,
Gürsu Kıyan
20   Department of Pediatric Surgery, Faculty of Medicine, Maramara University, Istanbul, Turkey
,
Ali Onur Erdem
21   Department of Pediatric Surgery, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
,
Osman Uzunlu 
22   Department of Pediatric Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
,
Abdullah Yıldız
23   Department of Pediatric Surgery, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
,
Esra Özçakır
24   University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
,
Nazile Ertürk
25   Department of Pediatric Surgery, Faculty of Medicine, Muğla Sıtkı Kocaman University, Muğla, Turkey
,
Başak Erginel
26   Department of Pediatric Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
,
Tülin Öztaş 
27   University of Health Sciences, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey
,
Ahmet Atıcı
28   Department of Pediatric Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
,
Mehmet Mert
29   Department of Pediatric Surgery, University of Health Sciences Van Training and Research Hospital, Van, Turkey
,
Hakan Samsum
30   Department of Pediatric Surgery, Private Antakya Academy Hospital, Hatay, Turkey
,
Mehmet Ali Özen
31   Department of Pediatric Surgery, School of Medicine, Koç University, Istanbul, Turkey
,
Emrah Aydın 
32   Department of Pediatric Surgery, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
,
Serpil Sancar
33   Department of Pediatric Surgery, Bursa City Hospital, Bursa, Turkey
› Author Affiliations Funding None.
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Abstract

Introduction Anastomotic stricture (AS) is the second most common complication after esophageal atresia (EA) repair. We aimed to evaluate the data in the Turkish Esophageal Atresia Registry to determine the risk factors for AS development after EA repair in a large national cohort of patients.

Methods The data between 2015 and 2021 were evaluated. Patients were enrolled into two groups according to the occurrence of AS. Patients with AS (AS group) and without AS (non-AS group) were compared according to demographic and operative features, postoperative intubation status, and postoperative complications, such as anastomotic leaks, fistula recanalization, and the presence of gastroesophageal reflux (GER). A multivariable logistic regression analysis was performed to define the risk factors for the development of AS after EA repair.

Results Among the 713 cases, 144 patients (20.19%) were enrolled into the AS group and 569 (79.81%) in the non-AS group. The multivariable logistic regression showed that, being a term baby (odds ratio [OR]: 1.706; p = 0.006), having a birth weight over 2,500 g (OR: 1.72; p = 0.006), presence of GER (OR: 5.267; p < 0.001), or having a recurrent tracheoesophageal fistula (TEF, OR: 4.363; p = 0.006) were the risk factors for the development of AS.

Conclusions The results of our national registry demonstrate that 20% of EA patients developed AS within their first year of life. In patients with early primary anastomosis, birth weight greater than 2,500 g and presence of GER were risk factors for developing AS. When patients with delayed anastomosis were included, in addition to the previous risk factors, being a term baby, and having recurrent TEF also became risk factors.

Level of Evidence III.

Keywords

esophageal atresia - tracheoesophageal fistula - anastomotic strictures - risk factors

Note

The study is presented at 7th World Congress of the World Federation of Associations of Pediatric Surgeons (WOFAPS)—2022, Prague, as an oral presentation.




Publication History

Received: 20 September 2023

Accepted: 05 June 2024

Accepted Manuscript online:
07 June 2024

Article published online:
28 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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