Abstract
BackgroundAnastomotic stricture (AS) is the most frequently occurring complication that occurs after esophageal atresia (EA) repair. Nevertheless, the pathogenesis remains primarily unknown and there is inadequate knowledge regarding the risk factors for AS. Therefore, a systematic review of the literature and a meta-analysis was performed to investigate whether gender and birth weight were risk factors for the development of AS following EA repair.MethodsThe main outcome measure was the occurrence of AS. Forest plots with odds ratios (OR) and 95% confidence intervals (CI) were generated for the outcomes. Quality assessment was performed using the Newcastle–Ottawa scale.ResultsSix studies with a total of 495 patients were included; 59% males, and 37 and 63% of the patients weighed < 2500 g and ≥ 2500 g, respectively. Male gender (OR, 0.96; 95% CI, 0.66–1.40; p = 0.82) and birth weight < 2500 g (OR, 0.74; 95% CI, 0.47–1.15; p = 0.18) did not increase the risk of AS. The majority of the included studies were retrospective cohort studies and the overall risk of bias was considered to be low to moderate.ConclusionNeither gender nor birth weight appear to have an impact on the risk of AS development following EA repair.
Highlights
Anastomotic stricture (AS) is the most frequently occurring complication that occurs after esophageal atresia (EA) repair
Long-gap EA, which is exposed to increased tension in the anastomosis, is considered to be more likely to form AS; in addition, recent studies confirm that anastomotic tension is an independent risk factor of AS development [7, 8]
After reviewing the patient characteristics in the chosen articles, eight articles were found to qualify for the metaanalysis; two of them belonged to the same cohort [10, 17]
Summary
Anastomotic stricture (AS) is the most frequently occurring complication that occurs after esophageal atresia (EA) repair. A systematic review of the literature and a meta-analysis was performed to investigate whether gender and birth weight were risk factors for the development of AS following EA repair. Excluding the immediate postoperative complications, the most frequently occurring complication affecting postoperative morbidity is the development. A few risk factors for developing AS are known far, and their incidence may be affected by the type of EA. Long-gap EA, which is exposed to increased tension in the anastomosis, is considered to be more likely to form AS; in addition, recent studies confirm that anastomotic tension is an independent risk factor of AS development [7, 8]. Recent studies have indicated that antireflux medication does not reduce the development of AS; proton pump inhibitors (PPI) are still used, possibly because they are considered to be harmless [8, 9]
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