208 Chapter 9 risk of anastomotic stenosis and leakage? (3) What are perioperative factors associated to anastomotic stenosis and leakage? Method Patients and management All young children (≤ 3 years of age) who underwent a primary anastomosis between January 1998 and December 2018 at the Amsterdam university medical centres were enrolled from a surgical administrative database. The study protocol was approved by the ethical review board of the Amsterdam university medical centre in the Netherlands (reference number: W18_233#18.278). Patients and parents received an opt-out letter for consent. Afterwards patient records were checked for eligibility. Data was stored in an electronic database (Castor EDC) (11). Data extraction For anastomotic leakage the definition and classification of the International Study Group of Rectal Cancer (ISREC) was used, recently described in a Delphi study (12, 13). Since there is a lack of consensus for the definition for anastomotic stenosis, no strict definition was used. Anastomotic stenosis was assumed in patients with obstructive symptoms and an observation of a stenosis at the anastomotic sight during surgery or on contrast enema. Stenosis following treatment for Hirschsprung’s disease were only noted if either redo-surgery was necessary without findings of residual aganglionosis or if anal dilatations were deemed necessary. Constipation which cleared following botulin injections were not included. In necrotizing enterocolitis, an anastomotic stenosis was only included when it was described in the surgical report at the sight of anastomosis as to distinguish them from post necrotizing enterocolitis stenosis. Patients that died within a week following primary anastomosis were not included in the analysis of anastomotic stenosis but were included in the analysis of anastomotic leakage. Time from surgery until the development of an anastomotic complication was recorded as well as duration of follow up, mode of diagnosing the complication, surgical and nonsurgical re-interventions, and complications following re-intervention. No procedures were excluded. The following data were retrieved from operative reports: surgical approach (laparotomy/laparoscopy), if surgery was urgent (executed within 72 hours following admission yes or no), history of prematurity (gestational age <37 weeks) and American Society of Anaesthesiologists (ASA) score before operation (grouped as ASA ≤II or ≥III). Information on the location of the anastomosis (small intestine, colonic or ileocolic), type of anastomosis (end-to-end (e-e), end-to-side (e-s) or side-to-side (s-s)),
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