Cargando…

Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children

OBJECTIVE: Little is known about intestinal anastomotic leakage and stenosis in young children (≤3 years of age). The purpose of this study is to answer the following questions: (1) what is the incidence of anastomotic stenosis and leakage in infants? (2) which surgical diseases entail the highest i...

Descripción completa

Detalles Bibliográficos
Autores principales: Eeftinck Schattenkerk, Laurens D., Musters, Gijsbert D., de Jonge, Wouter J., van Heurn, L.W. (Ernest), Derikx, Joep PM
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10476123/
https://www.ncbi.nlm.nih.gov/pubmed/37671119
http://dx.doi.org/10.1136/wjps-2023-000565
_version_ 1785100859449802752
author Eeftinck Schattenkerk, Laurens D.
Musters, Gijsbert D.
de Jonge, Wouter J.
van Heurn, L.W. (Ernest)
Derikx, Joep PM
author_facet Eeftinck Schattenkerk, Laurens D.
Musters, Gijsbert D.
de Jonge, Wouter J.
van Heurn, L.W. (Ernest)
Derikx, Joep PM
author_sort Eeftinck Schattenkerk, Laurens D.
collection PubMed
description OBJECTIVE: Little is known about intestinal anastomotic leakage and stenosis in young children (≤3 years of age). The purpose of this study is to answer the following questions: (1) what is the incidence of anastomotic stenosis and leakage in infants? (2) which surgical diseases entail the highest incidence of anastomotic stenosis and leakage? (3) what are perioperative factors associated with anastomotic stenosis and leakage? METHODS: Patients who underwent an intestinal anastomosis during primary abdominal surgery in our tertiary referral centre between 1998 and 2018 were retrospectively included. Both general incidence and incidence per disease of anastomotic complications were determined. Technical risk factors (location and type of anastomosis, mode of suturing, and suture resorption time) were evaluated by multivariate Cox regression for anastomotic stenosis. Gender and American Society of Anaesthesiology (ASA) score of ≥III were evaluated by χ(2) test for anastomotic leakage. RESULTS: In total, 477 patients underwent an anastomosis. The most prominent diseases are intestinal atresia (30%), Hirschsprung’s disease (29%), and necrotizing enterocolitis (14%). Anastomotic stenosis developed in 7% (34/468) of the patients with highest occurrence in necrotizing enterocolitis (14%, 9/65). Colonic anastomosis was associated with an increased risk of anastomotic stenosis (hazard ratio (HR) =3.6, 95% CI 1.8 to 7.5). No technical features (type of anastomosis, suture resorption time and mode of suturing) were significantly associated with stenosis development. Anastomotic leakage developed in 5% (22/477) of the patients, with the highest occurrence in patients with intestinal atresia (6%, 9/143). An ASA score of ≥III (p=0.03) and male gender (p=0.03) were significantly associated with anastomotic leakage. CONCLUSIONS: Both anastomotic stenosis and leakage are major surgical complications. Identifying more patient specific factors can result in better treatment selection, which should not solely be based on the type of disease.
format Online
Article
Text
id pubmed-10476123
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-104761232023-09-05 Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children Eeftinck Schattenkerk, Laurens D. Musters, Gijsbert D. de Jonge, Wouter J. van Heurn, L.W. (Ernest) Derikx, Joep PM World J Pediatr Surg Original Research OBJECTIVE: Little is known about intestinal anastomotic leakage and stenosis in young children (≤3 years of age). The purpose of this study is to answer the following questions: (1) what is the incidence of anastomotic stenosis and leakage in infants? (2) which surgical diseases entail the highest incidence of anastomotic stenosis and leakage? (3) what are perioperative factors associated with anastomotic stenosis and leakage? METHODS: Patients who underwent an intestinal anastomosis during primary abdominal surgery in our tertiary referral centre between 1998 and 2018 were retrospectively included. Both general incidence and incidence per disease of anastomotic complications were determined. Technical risk factors (location and type of anastomosis, mode of suturing, and suture resorption time) were evaluated by multivariate Cox regression for anastomotic stenosis. Gender and American Society of Anaesthesiology (ASA) score of ≥III were evaluated by χ(2) test for anastomotic leakage. RESULTS: In total, 477 patients underwent an anastomosis. The most prominent diseases are intestinal atresia (30%), Hirschsprung’s disease (29%), and necrotizing enterocolitis (14%). Anastomotic stenosis developed in 7% (34/468) of the patients with highest occurrence in necrotizing enterocolitis (14%, 9/65). Colonic anastomosis was associated with an increased risk of anastomotic stenosis (hazard ratio (HR) =3.6, 95% CI 1.8 to 7.5). No technical features (type of anastomosis, suture resorption time and mode of suturing) were significantly associated with stenosis development. Anastomotic leakage developed in 5% (22/477) of the patients, with the highest occurrence in patients with intestinal atresia (6%, 9/143). An ASA score of ≥III (p=0.03) and male gender (p=0.03) were significantly associated with anastomotic leakage. CONCLUSIONS: Both anastomotic stenosis and leakage are major surgical complications. Identifying more patient specific factors can result in better treatment selection, which should not solely be based on the type of disease. BMJ Publishing Group 2023-08-31 /pmc/articles/PMC10476123/ /pubmed/37671119 http://dx.doi.org/10.1136/wjps-2023-000565 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Eeftinck Schattenkerk, Laurens D.
Musters, Gijsbert D.
de Jonge, Wouter J.
van Heurn, L.W. (Ernest)
Derikx, Joep PM
Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children
title Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children
title_full Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children
title_fullStr Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children
title_full_unstemmed Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children
title_short Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children
title_sort should primary anastomosis be considered more? a retrospective analysis of anastomotic complications in young children
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10476123/
https://www.ncbi.nlm.nih.gov/pubmed/37671119
http://dx.doi.org/10.1136/wjps-2023-000565
work_keys_str_mv AT eeftinckschattenkerklaurensd shouldprimaryanastomosisbeconsideredmorearetrospectiveanalysisofanastomoticcomplicationsinyoungchildren
AT mustersgijsbertd shouldprimaryanastomosisbeconsideredmorearetrospectiveanalysisofanastomoticcomplicationsinyoungchildren
AT dejongewouterj shouldprimaryanastomosisbeconsideredmorearetrospectiveanalysisofanastomoticcomplicationsinyoungchildren
AT vanheurnlwernest shouldprimaryanastomosisbeconsideredmorearetrospectiveanalysisofanastomoticcomplicationsinyoungchildren
AT derikxjoeppm shouldprimaryanastomosisbeconsideredmorearetrospectiveanalysisofanastomoticcomplicationsinyoungchildren