Eur J Pediatr Surg 2013; 23(03): 204-213
DOI: 10.1055/s-0033-1347917
Review
Georg Thieme Verlag KG Stuttgart · New York

Anastomotic Stricture after Esophageal Atresia Repair: A Critical Review of Recent Literature

Robert Baird
1  Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
,
Jean-Martin Laberge
1  Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
,
Dominique Lévesque
2  Division of Pediatric Gastroenterology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
› Author Affiliations
Further Information

Publication History

02 May 2013

02 May 2013

Publication Date:
29 May 2013 (online)

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.