214 Chapter 9 Discussion This study evaluates the incidence of anastomotic complications in young children which is 7% for anastomotic stenosis and 5% for anastomotic leakage. Anastomotic stenosis occurs most often in patients treated for necrotizing enterocolitis (14%), Hirschsprung’s disease (9%) or intestinal atresia (6%), which is in line with previous reports (4). Anastomotic leakages develop most often after treatment for intestinal atresia (6%) followed by treatment for necrotizing enterocolitis (5%). The evaluation of technical factors as possible predictors for the development of anastomotic stenosis shows that colonic anastomosis is associated with an increased risk for the development of stenosis compared to those located in the small intestine. Other technical factors (type of anastomosis, suture resorption time, mode of suturing) are not significantly associated to the development of a stenosis, altough end-to-end anastomosis show a trend towards increased risk of stenosis. A higher ASA score (≥III) and male sex are significantly associated with the development of anastomotic leakage. In all patients receiving a primary anastomosis, less than one percent died because of an anastomotic complication. Compared to small intestinal anastomosis, a colonic anastomoses is most at risk of stenosis development. Altough an explanation can’t be retrieved from our data, there are multiple hypotheses provided for this effect by the literature. The most simple explanation might be that, due to fluid resorption in the colon, the increased faecal consistency also increases the chances of a stenosis in the colon to become symptomatic (14). Additionally, it could be that the healing process between the two intestinal location differ, resulting in different anastomosis. This process of anastomotic healing is to a great extend unclear which is why there is no clear narrative yet (9, 15). However, there seem to be pathobiological differences between the small intestine and colon, such as the reaction to ischemia and re-perfusion, which could reasonably have an effect on the extend of anastomotic scarring (16). None of the technical factors in the creation of an anastomosis seem to be associated with stenosis development and therefore no recommendations can be given on this topic based on our data. However, it must be noted that end-to-end anastomosis show a trend towards increased risk of stenosis which was borderline non-significant (p = 0.07) in our cohort. The diameter of the intestinal lumen is smaller in an end-to-end anastomosis, compared to side-to-side anastomosis. As the anastomosis heals and the patients grows the lumen of an end-to-end anastomosis might more easily get obstructed, which might explain these results.
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