210 Chapter 9 intestinal atresias, 9% (12/136) of patients treated for Hirschsprung’s disease and 14% (9/65) of the patients treated for necrotizing enterocolitis. Of the patients treated for intestinal atresia, 2% (2/93) of the patients treated for a duodenal atresia developed a stenosis whilst 14% (7/49) of the patients treated for jejunoileal atresias developed a stenosis. Characteristics of the anastomoses are described in table 3. The stenosis developed in the colon in 53% (18/34) of the cases, 85% (29/34) developed following the usage of an end-to-end anastomoses. In none of the stapled anastomoses a stenosis occurred. In the subgroup of handsewn anastomoses, 63% (19/30, four unknowns) of the stenoses developed after using intermittent sutures and 59% (17/30, four unknowns) after using fast absorbing sutures. Redo-surgery was necessary in 68% (23/34) of all stenoses. The 11 patients who did not need redo-surgery were patients with a stenosis following treatment for Hirschsprung’s disease. Of the patients experiencing a stenosis with the need for redo-surgery a new handsewn anastomosis was created in 75% (17/23), a stoma was created in 17% (4/23), a stapled anastomosis in 4% (1/23) and in 4% (1/23) a strictureplasty was performed (Heineke-Mikulicz). Following redo, three patients died (8% of all stenosis, ≤ 1% of all patients) of which two patients with necrotizing enterocolitis who both died of multiorgan failure due to abdominal sepsis caused by multiple perforations and stenosis. One patient with intestinal atresia was diagnosed with a stenosis by contrast enema but, due to the combined impact of multiple congenital defects and sepsis, the patient passed away before surgery could be performed. From the patients who survived and in whom redo-anastomosis was performed, recurrence developed in 5% (1/20). Outcomes of technical factors which were analyzed as risk factors for stenosis are reported in table 4. Cox-regression analysis showed that colon-colonic anastomoses were of significantly increased hazard (HR: 3.0, 95%-CI: 1.4-6.7, p ≤ 0.01) for anastomotic stenosis development when compared to small intestine-small intestine anastomoses. Colon-colonic anastomoses were not significantly more at risk (p=0.327) of stenosis compared to ileocolic anastomosis. Type of anastomosis was not significantly associated to the development of a stenosis (side-to-side: p=0.29; end-to-end: p=0.29; end-to-side: p=0.98). A subgroup analysis, using cox-regression, into all handsewn anastomosis (excluding stapled anastomosis) showed no significance in hazard in resorption time (p=0.27) and mode of suturing (continuous or interrupted) (p=0.60).
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