207 Should primary anastomosis be feared less? A retrospective analysis of anastomotic complications in young children Chapter 9 Introduction Intestinal anastomotic stenosis and anastomotic leakages are serious postoperative complications which can lead to different outcomes ranging from sepsis to the necessity of a re-operation with a temporary stoma, all of which will extend hospital stay, increase morbidity and mortality (1, 2). In young children (≤ 3 years of age) treated for abdominal birth defects, anastomotic leakage occurs in up to 7% of colonic atresia patients, whilst 8% of patients treated for complex gastroschisis develop an anastomotic stenosis (3, 4). However, for many surgical procedures in young children the incidences of these complications are unknown. In critically ill infants, the risk of anastomotic leakage is perceived too high to safely create a primary anastomosis. In these infants an enterostomy is mostly created because this treatment is believed to create the best conditions to allow the underlying disease to heal. However, enterostomy can result in a high-output stoma, stoma prolapse, wound infections and significantly affect the quality of life of infant and parents. In addition, a secondary operation is necessary to restore bowel continuity, which might result in other postoperative complications including anastomotic leakage and stenosis (5, 6). Moreover, a history of enterostomy increases the risk of long-term complications such incisional hernia (7). Therefore, it seems advisable that enterostomies should only be performed in selective patient groups with increased risk of anastomotic leakage. Currently, there is no consensus in which cases a primary anastomosis can be performed safely. For this reason a temporary enterostomy is almost always created during primary surgery in certain diseases, such as necrotizing enterocolitis, deemed at high risk. However, the decision to perform a primary anastomosis or to create an enterostomy should be based on more patient specific risk factors that predict the risk of complications. In this manner anastomotic complications as well as possibly unnecessary enterostomies could be reduced. Therefore, identification of these risk factors is essential. For instance, factors describing the fitness of the infant prior to surgery such as the American Society of Anaesthesiology (ASA) score, could be related to anastomotic leakage (8). Furthermore, surgical techniques creating an anastomosis, such as continuous stitching or side-toside anastomosis, might be of influence in anastomotic stenosis. Currently, there is no uniform surgical technique in which an intestinal anastomosis should be created to minimize the risk of postoperative complications in infants(9, 10). The purpose of this retrospective cohort study, including young children (≤ 3 years of age) who underwent a primary intestinal anastomosis between 1998 and 2018 in our tertiary clinic, is to answer the following questions: (1) What is the incidence of anastomotic stenosis and leakage in young children? (2) Which surgical diseases entail the highest
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