title: Evaluation of the intraoperative risk factors for esophageal anastomotic complications after primary repair of esophageal atresia with tracheoesophageal fistula.
abstract: OBJECTIVE
  The aim of this study is to identify the risk factors for esophageal anastomotic stricture (EAS) and/or anastomotic leakage (EAL) after primary repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) in infants.
  
  
  METHODS
  A retrospective chart review of 52 patients with congenital EA/TEF between January 2000 and December 2015 was conducted. Univariate and multivariate analyses were performed to identify the risk factors for anastomotic complications.
  
  
  RESULTS
  Twenty-four patients were excluded from the analysis because they had insufficient data, trisomy 18 syndrome, delayed anastomosis, or multi-staged operations; the remaining 28 were included. Twelve patients (42.9 %) had anastomotic complications. EAS occurred in 12 patients (42.9 %), and one of them had EAL (3.57 %). There was no correlation between anastomotic complications and birth weight, gestational weeks, sex, the presence of an associated anomaly, age at the time of repair, gap between the upper pouch and lower pouch of the esophagus, number of sutures, blood loss, and gastroesophageal reflux. Anastomosis under tension and tracheomalacia were identified as risk factors for anastomotic complications (odds ratio 15, 95 % confidence interval (CI) 1.53-390.0 and odds ratio 8, 95 % CI 1.33-71.2, respectively).
  
  
  CONCLUSIONS
  Surgeons should carefully perform anastomosis under less tension to prevent anastomotic complications in the primary repair of EA/TEF.
authors.affiliation: Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminami-chou, Chuo-ku, Kobe, 654-0081, Japan. yuichi.okata@gmail.com.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Okata
authors.affiliation: Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminami-chou, Chuo-ku, Kobe, 654-0081, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Bitoh
authors.affiliation: Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminami-chou, Chuo-ku, Kobe, 654-0081, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Mishima
authors.affiliation: Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminami-chou, Chuo-ku, Kobe, 654-0081, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Tamaki
authors.affiliation: Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminami-chou, Chuo-ku, Kobe, 654-0081, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Morita
authors.affiliation: Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminami-chou, Chuo-ku, Kobe, 654-0081, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Endo
authors.affiliation: Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminami-chou, Chuo-ku, Kobe, 654-0081, Japan.
authors.forename: Chieko
authors.initials: C
authors.lastname: Hisamatsu
authors.affiliation: Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminami-chou, Chuo-ku, Kobe, 654-0081, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Fukuzawa
authors.affiliation: Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminami-chou, Chuo-ku, Kobe, 654-0081, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Yokoi
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D055090:Tracheomalacia / Q000150:complications
keywords: Anastomotic leakage; Anastomotic stricture; Esophageal atresia; Risk factor; Tracheoesophageal fistula