Evaluation of Risk Factors for Anastomotic Complications after Surgical Repair of Esophageal Atresia
Tamara Hasan Abdullah, Ali Egab JodaAbstract
Background:
The most common and significant complications following surgical repair of esophageal atresia (EA) are related to esophageal anastomosis, and it greatly affects the overall outcomes. Although several factors have been implicated in the development of esophageal anastomotic complications, it is still unclear how we can predict these complications and the best way to prevent or at least decrease them.
Objective:
To identify and evaluate the risk factors for anastomotic complications after primary repair of EA.
Patients and Methods:
This was a prospective study of neonates having EA with primary surgical repair treated in a child central teaching hospital from June 2020 to December 2022. Analysis includes assessment of demographic data and clinical variables with recording the incidence of complications related to esophageal anastomosis. The enrolled patients were divided into two groups: those with an anastomotic complication (Group AC), including stricture, leak, and recurrent tracheoesophageal fistula (TEF) and those with no anastomotic complications (Group NAC). Then, we compared these two groups regarding the influence of these variables as suggested risk factors affecting the outcomes.
Results:
Of the total 63 patients diagnosed with TEF, 39 of them met the inclusion criteria. Twenty-two patients (56.4%) had early anastomotic complications, 19 patients (48.7%) had anastomotic leaks, 11 patients (28.2) had anastomotic stenosis, and 1 patient (2.6%) developed a recurrent fistula. Multivariate logistic regression analysis among the complication group reveals that aggressive esophageal mobilization, intermediate gap, anastomosis under tension, type of sutures, and neck flexion have significant statistical value.
Conclusions:
There is no correlation between variables of sex, body weight, gestational age, time of repair, use of transanastomotic feeding tube, and type of approach with the development of anastomotic complications. Variables of aggressive esophageal dissection, anastomosis under tension, intermediate gap, the use of non-absorbable sutures, and absent neck flexion postoperatively were identified as risk factors for early anastomotic complications.