206 Chapter 9 Abstract Purpose: Little is known about intestinal anastomotic leakage and -stenosis in young children (≤ 3 years of age). The purpose of this study is to answer the following questions: (1) What is the incidence of anastomotic stenosis and leakage in infants? (2) Which surgical diseases entail highest incidence of anastomotic stenosis and leakage? (3) What are perioperative factors associated to anastomotic stenosis and leakage? Methods: Patients who underwent an intestinal anastomosis during primary abdominal surgery in our tertiary referral centre between 1998 and 2018 were retrospectively included. Both general incidence and incidence per disease of anastomotic complications were determined. Technical risk factors (location and type of anastomosis, mode of suturing, suture resorption time) were evaluated by multivariate cox-regression for anastomotic stenosis. Gender and ASA score ≥III were evaluated by chi2-test for anastomotic leakage. Results: In total, 477 patients received an anastomosis. Most prominent diseases are intestinal atresia (30%), Hirschsprung’s disease (29%) and necrotizing enterocolitis (14%). Anastomotic stenosis developed in 7% (34/468) of the patients with highest occurrence in necrotizing enterocolitis (14%, 9/65). Colonic anastomosis are associated with an increased risk of anastomotic stenosis (Hazard ratio: 3.6, 95%-CI: 1.8-7.5). No technical features (type of anastomosis, suture resorption time, mode of suturing) are significantly associated with stenosis development. Anastomotic leakage developed in 5% (22/477) of the patients, with highest occurrence in patients with intestinal atresia (6%, 9/143). ASA score ≥III (p=0.03) and male gender (p=0.03) are significantly associated with anastomotic leakage. Conclusion: Both anastomotic stenosis and leakage are major surgical complications. Identifying more patient specific factors can result in better treatment selection which should not solely be based on type of disease.
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