Acid suppression duration does not alter anastomotic stricture rates after esophageal atresia with distal tracheoesophageal fistula repair: A prospective multi-institutional cohort study. J Pediatr Surg 2022 Jun;57(6):975-980
Date
03/20/2022Pubmed ID
35304025DOI
10.1016/j.jpedsurg.2022.02.004Scopus ID
2-s2.0-85126550825 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
INTRODUCTION: Anastomotic stricture is the most common complication after esophageal atresia (EA) repair. We sought to determine if postoperative acid suppression is associated with reduced stricture formation.
METHODS: A prospective, multi-institutional cohort study of infants undergoing primary EA repair from 2016 to 2020 was performed. Landmark analysis and multivariate Cox regression were used to explore if initial duration of acid suppression was associated with stricture formation at hospital discharge (DC), 3-, 6-, and 9-months postoperatively.
RESULTS: Of 156 patients, 79 (51%) developed strictures and 60 (76%) strictures occurred within three months following repair. Acid suppression was used in 141 patients (90%). Landmark analysis showed acid suppression was not associated with reduction in initial stricture formation at DC, 3-, 6- and 9-months, respectively (p = 0.19-0.95). Multivariate regression demonstrated use of a transanastomotic tube was significantly associated with stricture formation at DC (Hazard Ratio (HR) = 2.21 (95% CI 1.24-3.95, p<0.01) and 3-months (HR 5.31, 95% CI 1.65-17.16, p<0.01). There was no association between acid suppression duration and stricture formation.
CONCLUSION: No association between the duration of postoperative acid suppression and anastomotic stricture was observed. Transanastomotic tube use increased the risk of anastomotic strictures at hospital discharge and 3 months after repair.
Author List
Bowder AN, Bence CM, Rymeski BA, Gadepalli SK, Sato TT, Szabo A, Arendonk KV, Minneci PC, Downard CD, Hirschl RB, Markel T, Courtney CM, Deans KJ, Fallat ME, Fraser JD, Grabowski JE, Helmrath MA, Kabre RD, Kohler JE, Landman MP, Lawrence AE, Leys CM, Mak G, Port E, Saito J, Silverberg J, Slidell MB, St Peter SD, Troutt M, Wright TN, Lal DR, Midwest Pediatric ConsortiumAuthors
Christina Bence MD Assistant Professor in the Surgery department at Medical College of WisconsinDave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Data Science Institute department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Anastomosis, SurgicalCohort Studies
Constriction, Pathologic
Esophageal Atresia
Esophageal Stenosis
Humans
Infant
Postoperative Complications
Prospective Studies
Retrospective Studies
Tracheoesophageal Fistula
Treatment Outcome