209 Should primary anastomosis be feared less? A retrospective analysis of anastomotic complications in young children Chapter 9 mode of creating the anastomosis (sutured or stapled), mode of suturing (intermittent or continuously) and type of suture material used (VICRYL©, Novosyn©, Monocryl©, Monosyn plus© or Polydiazone (PDS)) were recorded. The time to resorption of the used suture material was categorized as normal (Vicryl©, Novosyn©, Monocryl©) or slow (PDS and Monosyn plus©). Statistical analysis Descriptive data were reported according to distribution as median with range or mean with standard deviation (SD). Multivariate Cox regression was performed using anastomotic stenosis as the outcome. A subgroup analysis using only handsewn anastomosis was performed also using multivariate Cox regression. The proportional hazard assumption was graphically checked by log-minus-log plot for every included variable. Forward Wald selection was used for selection of variables and assessment of confounding (increase in B-coefficient of >10%) and effect modification (significant interaction term). Significant risk factors were reported in hazard ratio (HR) with complementary 95% confidence intervals (95%-CI). Due to insufficient events-pervariable for anastomotic leakage, cox-regression analysis was not possible. Therefore, chi-squared (dichotomous and categorical variables) and Fisher’s exact test (dichotomous variables not meeting criteria for chi-squared) were used for this outcome accordingly. Results A total of 477 patients, distributed in 23 different conditions (Appendix 1), were treated with a primary anastomosis. Patient characteristics are described in Table 1. Out of all 477 patients receiving an anastomosis, 30% (143/477) were created to treat intestinal atresias, 29% (136/477) to treat Hirschsprung’s disease and 14% (67/477) to treat necrotizing enterocolitis. In 8% (36/477) of the patients the intestine was longitudinally incised and closed (Heineke-Mikulicz strictureplasty) as part of treatment of which 39% (14/37) were patients treated for duodenal atresia. A stapled anastomosis was created in 13% (61/477) of which 92% (56/61) underwent a Duhamel procedure for Hirschsprung’s disease and 8% (5/56) for intestinal atresia. The median follow-up was 770 days (IQR: 225 – 2125), 12% (59/477) had a follow-up of less than a year. Anastomotic stenosis Nine patients died within a week following surgery and were therefore not included. Anastomotic stenosis occurred in 7% (34/468) of patients after a median of 44 days (IQR: 25 - 209) following primary surgery and 83% (28/34) of the stenosis occurred within one year following surgery. In Table 2 the incidences of stenosis for each condition are described. An anastomotic stenosis developed in 8% (9/142) of patients treated for
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