title: Anastomotic stricture after esophageal atresia repair: a critical review of recent literature.
abstract: Anastomotic strictures (ASs) complicate the postoperative course of roughly one-third of all patients with esophageal atresia with or without tracheoesophageal fistula. Its development is multifactorial, but is due in part to tension on the anastomosis, gastroesophageal reflux disease, and the presence of a leak in the early postoperative period. Efforts at reducing the rate of AS have been largely unsuccessful, although meticulous technique and aggressive acid suppression remain the cornerstones of perioperative care. Once an AS has been confirmed, the first-line treatment remains a course of esophageal dilatation. Adjuncts to dilatation are frequently required, including steroid injection or the topical application of mitomycin C. Currently, there is insufficient evidence to promote one at the expense of the other. Esophageal stenting has recently been added to the algorithm of treatment, although additional literature is required to confirm its safety and efficacy. Finally, stricture resection followed by primary esophageal anastomosis or, rarely, esophageal replacement with an interposition graft remain options for AS refractory to all other forms of treatment.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada. robert.baird@mail.mcgill.ca
authors.forename: Robert
authors.initials: R
authors.lastname: Baird
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Laberge
authors.forename: Dominique
authors.initials: D
authors.lastname: Lévesque
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology* / Q000601:surgery; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D012086:Reoperation; D015607:Stents