Background/ Purpose: The most common complication following repair of esophageal atresia is anastomotic stricture. Despite strong opinions of pediatric surgeons regarding the type of suture used for the anastomosis, these opinions remain unsubstantiated by any data present in the literature. Therefore, we investigated the rate and severity of stricture formation relative to the suture size and material.
Materials & Methods: A retrospective analysis of our most recent 20-year experience with repair of esophageal atresia and tracheoesophageal fistula (EA/TEF) was performed. Stricture was defined as the need for dilation. Outcomes were analyzed based on absorbability, texture, and type of suture material. Results:Ninety-four patients were analyzed. There was no difference between absorbable (n=32) and non-absorbable sutures (n=62) in stricture rate, leak rate, or the number of dilations required in those with strictures. Braided suture was used in 79 patients compared to 15 with monofilament. There was no significant difference between groups in stricture rate, leak rate, or the number of dilations required in those with strictures. Comparing the 4 major classes of suture type used in this series (polyglycolic acid, silk, nylon, and polydiaxanone) there were no statistical differences in stricture rate or number of dilations required for those strictures.
Conclusion:The choice of suture utilized for the esophageal anastomosis during EA/TEF repair does not appear to the most critical factor on the development or severity of stricture formation.
Annals of Pediatric Surgery
Esophageal Atresia/surgery; Constriction, Pathologic; Sutures; Tracheoesophageal Fistula; Infant, Newborn
esophageal atresia and tracheoesophageal fistula; EA/TEF; stricture, suture material, suture size
St Peter, S. D., Valusek, P. A., Snyder, C. L., Holcomb, G. W., Ostlie, D. J. Impact of Suture Choice on Stricture Formation Following Repair of Esophageal Atresia Annals of Pediatric Surgery 3, 75-79 (2007).