Refractory Anastomotic Strictures Research Articles

Predictive factors for refractory anastomotic stricture after cervical triangular anastomosis with gastric conduit reconstruction through the posterior mediastinum in minimally invasive esophagectomy

BackgroundAfter esophagectomy, anastomotic strictures disturb food passage and increase the incidence of aspiration pneumonia. Multiple endoscopic balloon dilatations are required to treat strictures. As a result, long-term quality of life and nutritional status might be adversely affected. The aim of this study was to identify risk factors for strictures after cervical triangular anastomosis using gastric conduit among patients who underwent minimally invasive esophagectomy (MIE). Materials and MethodsIn total, 188 patients who underwent MIE for esophageal cancer between 2010 and 2020 at Kobe University Hospital were retrospectively examined. The incidence of strictures, number of dilatations for stricture, and time to stricture diagnosis were evaluated. Next, potential independent risk factor for refractory strictures requiring more than five endoscopic balloon dilatations was clarified. ResultsThe study included 188 patients who satisfied the inclusion criteria. Anastomotic strictures were observed in 44 patients (23%). Neoadjuvant chemotherapy was significantly more common in patients with stricture than in patients without stricture (75% vs. 58%, p = 0.041). The median number of endoscopic balloon dilations was 5 (range, 1–31); 30 patients (68%) underwent their first dilatation within 3 months after MIE. In univariate and multivariate analysis, less than 69 days from surgery to first endoscopic balloon dilatation was an independent risk factor for stricture requiring more than five endoscopic balloon dilatations after cervical triangular anastomosis in MIE (hazard ratio, 9.483; 95% confidence interval, 2.220–54.274; p = 0.002). ConclusionsIt is necessary to consider that early postoperative anastomotic stricture might become refractory and develop an appropriate treatment plan.

Safety and efficacy of liquid nitrogen spray cryotherapy-assisted balloon dilation for refractory anastomotic strictures.

Safety and efficacy of liquid nitrogen spray cryotherapy-assisted balloon dilation for refractory anastomotic strictures.

Use of a self-assembling peptide to control complications associated with endoscopic balloon dilation of refractory anastomotic stricture.

Use of a self-assembling peptide to control complications associated with endoscopic balloon dilation of refractory anastomotic stricture.

Endoscopic Stricturoplasty with Linear Stapler: An Efficient Alternative for the Refractory Rectal Anastomotic Stricture

IntroductionSymptomatic anastomotic stricture is a rare but major complication after left-sided colorectal surgery. Hydraulic balloon dilatation is the first-line treatment in cases where the complication occurs, but 20% of patients present with refractory strictures after multiple sessions. Endoscopic stricturoplasty with the use of a linear stapler is a novel therapeutic alternative for those difficult cases.Materials and MethodsWe identified all patients in our department who underwent endoscopic stricturoplasty with a linear stapler between 2004 and 2022. The technical, periinterventional, and follow-up data of the patients were retrospectively analyzed.ResultsWe identified nine patients who fulfilled our inclusion criteria. The procedure was technically possible in eight cases, whereas in one case, the anatomy of the anastomosis did not allow for a correct placement of the stapler. All patients with a technically successful procedure were relieved from their symptoms and could have their ostomy reversed. There was no periprocedural morbidity and mortality. Two patients presented with a recurrent stricture eight and 26 months after the initial stricturoplasty, and the procedure was successfully repeated in both cases.ConclusionsEndoscopic stricturoplasty is a feasible, safe, and minimally invasive alternative for the treatment of refractory anastomotic strictures in the distal colon and rectum for patients with a suitable anatomy.

512. COMBINATIONAL TREATMENT USING ENDOSCOPIC DILATION AND ORAL PREDNISOLONE FOR REFRACTORY ANASTOMOTIC STRICTURE AFTER ESOPHAGECTOMY

Abstract Anastomotic strictures are common complications after esophagectomy, and frequent dilatations to refractory strictures reduce patient’s QOL. Yamaguchi and colleagues have developed new treatments using oral prednisolone. They have shown the safety and potential efficacy to prevent esophageal strictures after ESD. However, the efficacy and safety of oral prednisolone is not evaluated to anastomotic stricture after esophagectomy. The aim of this study is to examine the safety of oral steroids therapy for postoperative esophageal stenosis. The subjects were patients who passed 28 days after the esophagectomy and recurred stenosis symptoms within 2 weeks after the dilatation, and who have undergone more than three or more dilations. Indication of oral steroids therapy was based on the definition of Kochman. Oral prednisolone was started at 30 mg/day after dilations, tapered gradually, and then discontinued for 12 weeks. The primary endpoint was safety evaluation. Secondary endpoints included stenosis rate at 85 days after initiation of steroid therapy, dysphagia score, number of dilations, change in weight, and duration of dilation interval, and enterostomy use rate. Five of six patients with refractory anastomotic strictures were enrolled. The risk factor for the incidence of refractory stenosis was ischemic changes around the entire anastomosis. The duration of hospital stay was significantly prolonged. All the patients completed the therapy and no adverse events were observed. There were two cases of re-strictures. Dilation frequency was significantly reduced (4.4 ± 1.1 vs. 1.4 ± 1.9, P < 0.01) and the intervals was significantly prolonged (11.9 ± 6.2 days vs. 60.5 ± 33.6 days, P = 0.02). Dysphagia scores were significantly improved (3.2 ± 0.8 vs 0.2 ± 0.4, P < 0.01). The rate of enterostomy use was significantly reduced (80% vs 0%, P = 0.02). Steroid therapy for esophageal stricture after esophagectomy may be safe and effective. Further studies are needed to evaluate the efficacy of steroid therapy in a large number of patients.

Radial incision and cutting under gel immersion as a useful method for refractory anastomotic stricture.

Radial incision and cutting under gel immersion as a useful method for refractory anastomotic stricture.

First treatment of Crohn’s disease refractory anastomotic stricture with a lumen-apposing metallic stent suitable for colonoscopy

First treatment of Crohn’s disease refractory anastomotic stricture with a lumen-apposing metallic stent suitable for colonoscopy

A combined abdominal and transanal minimally invasive (TAMIS) approach in redo anastomoses for severe refractory rectal strictures.

Anastomotic stricture following anterior resection is an uncommon but challenging problem. Endoscopic dilatation and transanal endoscopic surgery (TES) are proven methods of treatment. However, a small proportion of patients repeatedly fail transanal local therapy for underlying reasons of tension, insufficient blood supply or irradiated tissue, eventually necessitating a complete anastomotic excision. We aimed to combine transanal minimally invasive surgery (TAMIS) with an abdominal approach in redo anastomoses for severe refractory anastomotic strictures. For the TAMIS phase, we use a Lonestar® retractor with a GelPOINT® Path transanal access platform. A circumferential full thickness rectotomy is performed and the dissection is continued proximally in the mesorectal fascial plane past the strictured segment to meet the abdominal dissection or until the peritoneal cavity is entered, facilitating mobilization of the rectum. The abdominal phase is performed as usual with sufficient mobilization of the left colon to enable tension-free redo anastomosis. An accompanying video demonstrates this technique. Two patients with refractory anastomotic strictures following a previous low anterior resection underwent the procedure. One patient had laparoscopy followed by TAMIS and the other had TAMIS followed by laparotomy. Both cases were performed by surgeons experienced in laparoscopy and TES. One patient had postoperative ileus which resolved conservatively. Both anastomoses were widely patent on follow-up. TAMIS combined with a conventional abdominal approach offers significant technical advantages over a totally abdominal approach for the definitive management of patients with severe anastomotic strictures refractory to first-line methods of therapy. The operator should already be proficient with TES.

Early prediction of complex benign anastomotic stricture after esophagectomy using early postoperative endoscopic findings.

Benign anastomotic stricture after esophagectomy and reconstruction adversely affects oral intake and can increase the risk of aspiration pneumonia. Some patients experience relapse that requires frequent endoscopic dilatations. This study aimed to investigate whether the endoscopic appearance of anastomosis during the early postoperative period is associated with the complexity of subsequent anastomotic strictures. Data of 213 patients who underwent esophagectomy with gastric tube reconstruction and early postoperative endoscopy between July 2008 and September 2018 were prospectively collected. Relationships among various risk factors, including the severity of mucosal degeneration of the anastomosis and complexity of anastomotic stricture, were studied using multivariate logistic regression analysis. Fifty-three patients (25%) developed anastomotic strictures at a median of 55days after surgery, requiring a median of 5 endoscopic dilations. In multivariate analysis, severe mucosal degeneration was the only significant risk factor for any type of anastomotic stricture (P < 0.001). Twenty-seven patients (51%) developed refractory anastomotic strictures. In multivariate analysis, younger age (< 65years) (P = 0.01), lack of neoadjuvant therapy (P = 0.02), severe mucosal degeneration (P = 0.03), and stricture development within 55days (P = 0.01) were the risk factors for refractory stricture. The analysis of the risk factors for severe mucosal degeneration revealed that comorbidities and anastomotic techniques were independently correlated (P < 0.01). Early postoperative severe mucosal degeneration of esophagogastrostomy was the only predictor of strictures, regardless of their type. Mucosal degeneration, early postoperative stricture, younger age, and front surgery were associated with refractory anastomotic strictures.

Intraductal placement of non-flared fully covered metallic stent for refractory anastomotic biliary strictures after living donor liver transplantation: Long-term results of prospective multicenter trial.

Fully covered self-expandable metallic stent (FCSEMS) may be an effective modality for managing anastomotic biliary stricture (ABS) after liver transplantation. However, stent migration and stent-induced ductal injury are the main limitations. The objective of this study was to evaluate the usefulness of an unflared, intraductal FCSEMS that was designed to minimize migration and ductal injury for refractory ABS after living donor liver transplantation (LDLT). A total of 32 consecutive patients with symptomatic ABS after LDLT unresolved by plastic stents with or without balloon dilation at four tertiary medical centers were prospectively enrolled. A short (3 or 5cm) FCSEMS having long lasso (10cm) used in this study had unflared convex ends to minimize tissue hyperplasia and smaller center portion to prevent migration. The FCSEMS was placed above the papilla and removed at 3-4months after stenting. Technical and clinical success rates of intraductal placement with FCSEMS were 100% (32/32) and 81.2% (26/32), respectively. Early stent migration was observed in five (15.6%) patients. However, three patients with early stent migration had stricture resolution without needing additional intervention. Intended stent removal was successful in 27 (100%) patients (median, 101days; range, 23-118days). No stent-induced ductal change was observed in all patients. Stricture recurrence was observed in 11.5% (3/26) of patients during 639days of median duration of follow-up (range, 366-2079days). Intraductal placement of an unflared short FCSEMS may be a promising option for refractory ABS after LDLT with minimal stent-induced ductal injury and stent migration.

Treatment of refractory post-esophagectomy anastomotic esophageal strictures using temporary fully covered esophageal metal stenting compared to repeated bougie dilation: results of a randomized controlled trial.

Background and study aims Fully covered self-expanding metal stents (FCSEMS) provide an alternative to bougie dilation (BD) for refractory benign esophageal strictures. Controlled studies comparing temporary placement of FCSES to repeated BD are not available. Patients and methods Patients with refractory anastomotic esophageal strictures, dysphagia scores ≥ 2, and two to five prior BD were randomized to 8 weeks of FCSEMS or to repeated BD. The primary endpoint was the number of BD during the 12 months after baseline treatment. Results Eighteen patients were included (male 67 %, median age 66.5; 9 received metal stents, 9 received BD). Technical success rate of stent placement and stent removal was 100 %. Recurrent dysphagia occurred in 13 patients (72 %) during follow-up. No significant difference was found between the stent and BD groups for mean number of BD during follow-up (5.4 vs. 2.4, P = 0.159), time to recurrent dysphagia (median 36 days vs. 33 days, Kaplan-Meier: P = 0.576) and frequency of reinterventions per month (median 0.3 vs. 0.2, P = 0.283). Improvement in quality of life score was greater in the stent group compared to the BD group at month 12 (median 26 % vs. 4 %, P = 0.011). Conclusions The current data did not provide evidence for a statistically significant difference between the two groups in the number of BD during the 12 months after initial treatment. Metal stenting offers greater improvement in quality of life from baseline at 12 months compared to repeated BD for patients with refractory anastomotic esophageal strictures.

Refractory Anastomotic Rectal Stricture After Lower Anterior Resection and Radiation Exposure

We present a patient with history of neoadjuvant radiation and chemotherapy, with lower anterior resection, complicated with rectal anastomotic stricture refractory to endoscopic intervention. In the past, colorectal surgery had been the preferred method of treatment of rectal strictures, but endoscopic techniques, such as balloon dilation, have become the preferred modality. However, there is a high stricture recurrence rate of up to 18-20%, with increased risk of perforation due to uncontrolled stretching reported after balloon dilatation. A 68 year old female who migrated from West Africa with medical history of hypertension, Stage IIIB rectal cancer with low anterior resection and neoadjuvant chemo-radiation one year ago, presented to our gastrointestinal clinic for colon cancer surveillance. She denied melena, hematochezia, abdominal pain, diarrhea, nausea and vomiting, however noted a decrease in frequency of bowel movements. Colonoscopy performed revealed a very tight fibrotic stricture ˜8 cm from anal verge. With the use of a Through the scope (TTS ) balloon (6-7-8mm) dilation was performed. Minimal self limited mucosal oozing was noted. A subsequent flexible sigmoidoscopy was performed 2 weeks later with TTS using a larger sized balloon (8-9-10mm), which was inserted and dilation repeated. During a repeat colonoscopy performed 3 weeks later a very tight stricture was observed again in the rectum. Given recurrent stricturing / fibrosis - dilation was not attempted and was referred to colorectal surgery for surgical correction of stricture. Anastomotic stricture is a relatively common complication of low anterior resection especially in patients who had preoperative radiation. Endoscopic balloon dilatation is the most effective method to correct strictures, although repeated dilation over time is often required. There is some evidence in literature that dilating for the third or subsequent times may be futile. Even though balloon dilatation is a safe treatment, additional treatment modalities described in literature include; the use of neodymium: yttrium-aluminum-garnet laser treatment, electro-incision, electrocautery, and use of sphincterotomes. Colorectal Surgery should be considered in patients with recurrent strictures refractory to endoscopic therapy.2940 Figure 1. A very tight stricture ˜8 cm from anal verge seen. A TTS CRE ballon was inserted (6-7-8 cm) and dilation was performed. Minimal self limited oozing noted.

Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study

ObjectiveTo determine the incidence of refractory anastomotic strictures after oesophageal atresia (OA) repair and to identify risk factors associated with refractory strictures.MethodsRetrospective national multicentre study in patients with OA born...

Sa1294 PLASTIC BILIARY STENT PLACEMENT IS NON-INFERIOR TO METAL STENTS IN LONG-TERM MANAGEMENT OF REFRACTORY POST-LIVER TRANSPLANT ANASTOMOTIC STRICTURES

Anastomotic strictures occur in 5%-15% of deceased donor liver transplants and in up to 32% of live donor transplants. Endoscopic therapy includes balloon dilation and stenting, either via multiple plastic stents or use of self-expanding metal stents (SEMS). Recurrence rates after an initially-successful endoscopic treatment has been reported between 18-34% at one year follow-up. Very little literature is available on the long-term prognosis. Our aim was to describe the long-term success rate of plastic and SEMS in the management of post-transplant refractory anastomotic strictures. A retrospective analysis of consecutive patients undergoing endoscopic stent placement for refractory anastomotic strictures in a post-liver transplant population from 2010 to 2017 was conducted. Their age at first intervention, sex (percent male), reason for liver transplantion and number of ERCPs were collected. Patients were then separated by first SEMS indwelling time of <6 months or ≥6 months and by type of initial stent placed (SEMS vs. plastic). The mean number of ERCPs after the 1st SEMS was placed were compared in the 6 month indwelling time, and type of initial stent (SEMS vs. plastic) groups using student’s t-test. 31 patients were identified. Their mean age at intervention (first SEMS) is 53 years (range 36-74), and 74% (23) were males. The most common reasons for liver transplantation were combinations including non-alcoholic steatohepatitis n=6 (19%), alcoholic cirrhosis n=6 (19%), hepatocellular carcinoma n=6 (19%), primary biliary cholangitis n=4 (13%), primary sclerosing cholangitis n=3 (10%) and others. The mean number of total ERCPs was 6.7 ± 5.2, with a mean number of 4.3 ±3.5 ERCPs after 1st SEMS. Overall, 13 (42%) patients went straight to SEMS placement, and 18 (58.1%) had previously-placed plastic stents. Average follow up was 1283 days (range: 118-2641 days). Statistical analysis showed a trend toward no difference in the mean number of ERCPs required between patients who received SEMS versus plastic stents at their first procedure (4.1 ± 4.2 vs. 4.4 ± 3; p=0.7). There was also a trend towards no difference in the mean number of ERCP when SEMS were left in place more than 6 months versus for shorter periods of time (3.7 ± 3.1 vs 4.6 ± 3.6 ; p=0.55).Acute procedural adverse events included: pancreatitis n=4 (13%), post-ERCP abdominal pain n=3 (10%), bleeding n=2 (6.5%) and perforation n=1 (3%). Delayed procedure-related adverse events were cholangitis n=9 (29%), stricture development n=6 (19%), stenosis n=5 (16%) and stent migration n=9 (56%). Success of endoscopic stenting for refractory anastomotic strictures in post-liver transplant patients does not appear to be affected by various stenting paradigms in the long term. Specifically, SEMS are no better than plastic stents in this unique patient population.

973 OPEN SESAME: A NOVEL LUMEN APPOSING METAL STENT DEPLOYMENT SYSTEM FOR THE MANAGEMENT OF SHORT LUMINAL STRICTURES

The use of short, fully-covered lumen apposing metal stents (LAMS) has emerged as a novel therapeutic intervention in the management of short luminal strictures. Similar to self-expanding metal stents (SEMS), LAMS are self-expanding and removable. Unlike SEMS, LAMS have lumen-apposing proximal and distal flanges, which may limit the risk of migration. LAMS are designed to be deployed via a therapeutic echoendoscope. When LAMS deployment is attempted with a therapeutic gastroscope, the much longer length of the deployment catheter relative to the gastroscope and inability to luer lock the catheter in place result in unstable endoscopic visualization and need for a second operator. These difficulties predispose to inaccurate stent placement. We demonstrate a video series including four patients with disparate pathologies resulting in luminal strictures in whom we successfully implemented a novel, alternative LAMS deployment system. At bedside, the 10 mm x 15 mm LAMS, which was previously deployed from the catheter, is pulled with standard grasping forceps into the 3.7 mm accessory channel of the therapeutic gastroscope. The scope tip is then advanced to the stricture, and the LAMS is pushed out under fluoroscopy until the distal flange opens. As the scope is slowly withdrawn, the proximal flange is deployed under endoscopic visualization. The deployed stent is then dilated with a through the scope balloon to obtain maximal stent expansion. This technique is now demonstrated in the following patients: 1. A 70 year old woman with ulcerative colitis, status post total proctocolectomy with ileal pouch-anal anastomosis, complicated by refractory pouchitis and pouch-vaginal fistula, on infliximab, presented over a decade later for management of a refractory anastomotic stricture at the inflow tract to the pouch. 2. A 48 year old woman with disseminated tuberculosis and actinomyces complicated by esophageal fistula, status post partially covered esophageal stent placement, since removed, presented with odynophagia 2 months later secondary to an upper esophageal stricture refractory to balloon dilation. 3. A 63 year old woman with HBV cirrhosis status post esophageal variceal band ligation, complicated by mid-esophageal stricture formation less than 2 weeks later, who was initially treated with balloon dilation and fully covered SEMS placement, returned due to stricture recurrence following distal SEMS migration. 4. A 59 year old male with recurrent diverticulitis status post open sigmoidectomy complicated by anastomotic breakdown requiring a diverting loop ileostomy, developed a complete obstruction at the colorectal anastomosis refractory to balloon dilation. With use of our novel technique, we were able to easily and accurately place LAMS across these short luminal strictures, thus obtaining symptom alleviation for our patients and avoiding surgery.

Impact of Mucosal Degeneration of Gastric Conduit on Refractory Anastomotic Stricture after Esophagectomy

Impact of Mucosal Degeneration of Gastric Conduit on Refractory Anastomotic Stricture after Esophagectomy

Efficacy and Optimal Duration of Metallic Stent in the Management of Refractory Anastomotic Stricture After Liver Transplantation

Anastomotic bile duct stricture (ABS) remains as one of the most common complications in liver transplant patients. Current practice of endoscopic retrograde cholangiopancreatography (ERCP) with insertion of plastic stent often requires multiple procedures before achieving stricture resolution. To date, studies using covered self-expandable metallic stent (cSEMS) in ABS management reported varying degrees of efficacy. The aim of this study was to analyze long-term efficacy of cSEMS in patients with ABS and identify factor(s) influencing the probability of stricture resolution. Liver transplant patients with ABS who received cSEMS were identified by query of our endoscopic database. The rate of stricture resolution, duration of stricture-free interval, factors associated with stricture resolution, and adverse outcomes were analyzed. Among 44 liver transplant patients with refractory ABS who underwent ERCP-cSEMS, stricture resolution was observed in 33 patients (75%). Longer duration of cSEMS insertion was the only variable associated with increasing probability of stricture resolution. There was 20% increase in odds of stricture resolution for every additional week cSEMS was in place. Among 33 patients with initial stricture resolution, 26 patients (78.8%) maintained bile duct patency throughout the follow-up period. The most common adverse outcome was internal migration of cSEMS, which occurred in 11 patients (25%). The rate of ABS resolution observed with cSEMS placement in a single ERCP session appears to be comparable with that of multiple ERCPs with plastic stent placement reported previously. Longer stent insertion period is associated with higher likelihood of ABS resolution.

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures.

Improved surgical techniques, as well as preoperative and postoperative care, have dramatically changed survival of children with esophageal atresia (EA) over the last decades. Nowadays, we are increasingly seeing EA patients experiencing significant short- and long-term gastrointestinal morbidities. Anastomotic stricture (AS) is the most common complication following operative repair. An esophageal stricture is defined as an intrinsic luminal narrowing in a clinically symptomatic patient, but no symptoms are sensitive or specific enough to diagnose an AS. This review aims to provide a comprehensive view of AS in EA children. Given the lack of evidence-based data, we critically analyzed significant studies on children and adults, including comments on benign strictures with other etiologies. Despite there is no consensus about the goal of the luminal diameter based on the patient’s age, esophageal contrast study, and/or endoscopy are recommended to assess the degree of the narrowing. A high variability in incidence of ASs is reported in literature, depending on different definitions of AS and on a great number of pre-, intra-, and postoperative risk factor influencing the anastomosis outcome. The presence of a long gap between the two esophageal ends, with consequent anastomotic tension, is determinant for stricture formation and its response to treatment. The cornerstone of treatment is endoscopic dilation, whose primary aims are to achieve symptom relief, allow age-appropriate capacity for oral feeding, and reduce the risk of pulmonary aspiration. No clear advantage of either balloon or bougie dilator has been demonstrated; therefore, the choice is based on operator experience and comfort with the equipment. Retrospective evidences suggest that selective dilatations (performed only in symptomatic patients) results in significantly less number of dilatation sessions than routine dilations (performed to prevent symptoms) with equal long-term outcomes. The response to dilation treatment is variable, and some patients may experience recurrent and refractory ASs. Adjunctive treatments have been used, including local injection of steroids, topical application of mitomycin C, and esophageal stenting, but long-term studies are needed to prove their efficacy and safety. Stricture resection or esophageal replacement with an interposition graft remains options for AS refractory to conservative treatments.

1154 A Multi-Center, Prospective, Randomized Study Comparing a Fully Covered Esophageal Metal Stent to Bougie Dilation for the Treatment of Refractory Anastomotic Esophageal Strictures

1154 A Multi-Center, Prospective, Randomized Study Comparing a Fully Covered Esophageal Metal Stent to Bougie Dilation for the Treatment of Refractory Anastomotic Esophageal Strictures

Postoperative Complications and Functional Outcome after Esophageal Atresia Repair: Results from Longitudinal Single-Center Follow-Up

BackgroundEsophageal atresia (EA) and tracheoesophageal fistula (TEF) represent major therapeutic challenges, frequently associated with serious morbidities following surgical repair. The aim of this longitudinal study was to assess temporal changes in morbidity and mortality of patients with EA/TEF treated in a tertiary-level center, focusing on postoperative complications and their impact on long-term gastroesophageal function. MethodsOne hundred nine consecutive patients with EA/TEF born between 1975 and 2011 were followed for a median of 9.6 years (range, 3–27 years). Comparative statistics were used to evaluate temporal changes between an early (1975–1989) and late (1990–2011) study period. ResultsGross types of EA were A (n = 6), B (n = 5), C (n = 89), D (n = 7), and E (n = 2). Seventy (64.2%) patients had coexisting anomalies, 13 (11.9%) of whom died before EA correction was completed. In the remaining 96 infants, surgical repair was primary (n = 66) or delayed (n = 25) anastomosis, closure of TEF in EA type E (n = 2), and esophageal replacement with colon interposition (n=2) or gastric transposition (n=1). Long-gap EA was diagnosed in 23 (24.0%) cases. Postoperative mortality was 4/96 (4.2%). Overall survival increased significantly between the two study periods (42/55 vs. 50/54; P = 0.03). Sixty-nine (71.9%) patients presented postoperatively with anastomotic strictures requiring a median of 3 (range, 1–15) dilatations. Revisional surgery was required for anastomotic leakage (n = 5), recurrent TEF with (n = 1) or without (n=9) anastomotic stricture, undetected proximal TEF (n = 4), and refractory anastomotic strictures with (n = 1) or without (n = 2) fistula. Normal dietary intake was achieved in 89 (96.7%) patients, while 3 (3.3%) remained dependent on gastrostomy feedings. Manometry showed esophageal dysmotility in 78 (84.8%) infants at 1 year of age, increasing to 100% at 10-year follow-up. Fifty-six (60.9%) patients suffered from dysphagia with need for endoscopic foreign body removal in 12 (13.0%) cases. Anti-reflux medication was required in 43 (46.7%) children and 30 (32.6%) underwent fundoplication. The rate of gastroesophageal reflux increased significantly between the two study periods (29/42 vs. 44/50; P = 0.04). Twenty-two (23.9%) cases of endoscopic esophagitis and one Barrett’s esophagus were identified. ConclusionsPostoperative complications after EA/TEF repair are common and should be expertly managed to reduce the risk of long-term morbidity. Regular multidisciplinary surveillance with transitional care into adulthood is recommended in all patients with EA/TEF.