Slide Esophagoplasty vs. End-to-End Anastomosis for Recalcitrant Esophageal Stricture After Esophageal Atresia Repair
*Ali Kamran, *Charles J. Smithers, *Michael A. Manfredi, Thomas E. Hamilton, *Peter D. Ngo, *David Zurakowski, Russell W. Jennings
Boston Children's Hospital, Boston, MA
Objective: To compare patient outcomes of slide esophagoplasty and conventional end-to-end anastomosis for treatment of recalcitrant anastomotic stricture after esophageal atresia (EA) repair. Design: Retrospective cohort study (July 2010 - January 2017). Setting: Single Institution Esophageal Atresia Center. Patients: EA patients (27 Females, 24 Males) who underwent anastomotic stricture resection at median age 15 months (IQR 6-22). Interventions: Slide esophagoplasty after stricture resection in which sliding anastomosis was performed compared to the conventional approach of end-to-end anastomosis. Main Outcome Measures: Endoscopic therapies required postoperatively to maintain lumen patency, including dilation, steroid injection, stent placement, or stricture incision. Incidence of anastomotic leaks in the immediate postoperative period was considered as well. Results: Fifty-one patients underwent stricture repair surgery by slide (12) or end-to-end (39) technique. Significantly fewer patients required dilation therapy following slide esophagoplasty, 5/12 (42%) with a median of 3 dilations compared with 33/39 (85%) in end-to-end group with 4 dilations (42% vs. 85%, P = 0.006). Steroid injection was combined with dilation therapy in 2/12 (16%) vs. 22/39 (56%) in slide and end-to-end groups, respectively (P = 0.02). Stent placement was used in none of slide cases vs. 7/39 (18%) of end-to-end (P = 0.18). Stricture incision was performed in 1/12 (8%) of slide group and 11/39 (28%) of end-to-end (P = 0.25). Leak complications occurred in fewer patients following slide esophagoplasty compared to end-to-end anastomosis: 1/12 (8%) vs. 9/39 (23%) (P = 0.42). Conclusions: Slide esophagoplasty patients required fewer postoperative endoscopic interventions compared to end-to-end anastomosis. Slide esophagoplasty may be the preferred surgical approach for selected patients with recalcitrant esophageal stricture, although more patients and longer follow-up are needed to provide stronger evidence.
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