Risk factors for stricture formation after esophageal atresia repair

Tate Nice, Benjamin Tuanama Diaz, Michelle Shroyer, David Rogers, Mike Chen, Colin Martin, Elizabeth Beierle, Beverly Chaignaud, Scott Anderson, Robert Russell

Research output: Contribution to journalReview articlepeer-review

29 Scopus citations

Abstract

Purpose: Esophageal stricture remains a common morbidity of esophageal atresia (EA) repair. The purpose of this study was to examine the association of multiple pre- and postoperative variables with stricture formation after EA repair. Methods: A retrospective review of all patients who underwent EA repair was performed from June 1999 to January 2014, excluding patients who died prior to discharge. Data were collected on patient demographics, disease specifics, treatment, and outcomes. A clinically significant esophageal stricture was defined as those requiring more than three esophageal dilations. Univariate analysis and multivariate analysis was performed to determine associations with stricture formation. Results: The study included 121 infants. On univariate analysis, tracheoesophageal fistula (TEF) Gross classification (P = .046), method of repair (P = .0099), surgery staging (P = .0211), and development of leak (P = .0479) had a statistically significant association with stricture formation. Most (81%) underwent open repair with a stricture rate of 16.3%, while 20 patients underwent thoracoscopic repair with a 40% stricture rate. Multivariate analysis showed that patients undergoing a staged repair had increased risk of stricture formation over primary repair (odd ratio [OR] 6.360; P = .0008). Thoracoscopic surgery also increased the risk of stricture (OR 7.409; P = .0014). Cardiovascular anomalies were found to be associated with decreased stricture formation (OR 0.251; P = .0083). Conclusion: Thoracoscopic repair and staged repair were both associated with increased risk of clinically significant stricture formation after TEF repair. However, the presence of cardiovascular anomalies was associated with decreased stricture formation. TEF Gross classification also affects stricture risk.

Original languageEnglish
Pages (from-to)393-398
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume26
Issue number5
DOIs
StatePublished - May 2016

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