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Anastomotic stricture after esophageal atresia surgery

R. Sfeir, L. Michaud, M. Bonnevalle,RH. Priso , E. Aubry, F. Gottrand, R. Besson

Pediatric Unit, Jeanne de Flandre Hospital, CHRU Lille, France

 

ABSTRACT

Aim: To study in a population of children operated at birth for type III or V of esophageal atresia the frequency and the associated factors for anastomotic stricture, and the efficacy of the esophageal dilations.

Material and methods: Sixty-two children were operated from 2000 to 2005. The characteristics of the children having an anastomotic stricture were compared with those of the children without stricture. The elapsed time between the surgical anastomosis and the first dilation (Savary dilators), as well as the number and the dilatations efficacy (disappearance of the dysphagia) were noted. Results: Twenty-three children (37%) presented a stricture. With univariated analysis, the birth weight, the use of curare, the duration the trans-anastomotic or mediastinal drainage were not different in the, 2 groups. On the other hand, the tension at the site of anastomosis (43% versus 10%), anastomotic leaks (30% against 5%), the presence of gastro-esophageal reflux (GER) (91% versus 61%) were significantly associated with anastomotic stricture (p< 0,05). In multivariate analysis only the tension at the site of anastomosis was associated with stricture (p< 0.05). The average interval between the surgery and the first dilatation was 149 days (extremes: 30-600 days). The number of dilatations varied from 1 to 7 (average: 3, 2 ± 2 per child) over a 7 months average period (extremes: 0-55 month). Three children remained with a moderate dysphagia (N = 1) or severe dysphagia (N= 2) in a 2 years fallow-up. No complication related to the dilatations was observed.

Conclusions: Anastomotic stenosis after surgical treatment of the EA is frequent, it is influenced by the length of the atretic segment, by the anastomotic leaks and the by the GER. The esophageal dilatation with Savary dilators is effective, but several dilatations are usually necessary.

 

Key words: esophageal atresia, anastomotic stricture, anastomotic leaks