264 Chapter 12 Table 3 – Comparison of postoperative complications Complication Primary anastomosis (N=48) Combined risk enterostomy (N=31) Statistics*1 (N=missing) (N=missing) Early complications Clavien-Dindo ≥III 15 (31%) 19 (61%) (N=1) P ≤ 0.01 Surgical site infection 1 (2%) 6 (19%) (N=1) F = 0.01 Wound dehiscence 1 (2%) 7 (23%) (N=1) F ≤ 0.01 Central venous catheter infection 18 (38%) 14 (45%) (N=1) P = 0.63 Cholestasis 19 (40%) (N=4) 16 (52%) (N=1) P = 0.14 Late complications Short bowel syndrome 11 (25%) (N=4) 14 (48%) (N=3) P = 0.03 Anastomotic leakage 4 (9%) 3 (10%) (N=1) F = 1 Anastomotic stenosis 8 (17%) 9 (30%) P = 0.19 Adhesive bowel obstruction 4 (8%) 8 (25%) P = 0.03 Incisional hernia 1 (2%) 3 (9%) F = 0.30 Mortality 2 (4%) 3 (10%) F = 0.38 *1 = by Chi-squared or Fisher’s exact (shown as F = ..) when applicable. Discussion This retrospective analysis of two routinely performed treatment strategies for neonates with jejunoileal atresia is the first to demonstrate the risk of postoperative complications taking into account both operations needed for enterostomy creation and reversal. Our results suggest that: 1) patients with an enterostomy, compared to patients with primary anastomosis, more often suffer from severe postoperative complications (Clavien-Dindo ≥III) and (2) Patients treated by enterostomy encounter significantly more short- (surgical site infections, wound dehiscence) and long-term (short-bowel syndrome, adhesive bowel obstruction) postoperative complications. In addition, enterostomy complications often warranting redo surgery, such as high-output enterostomy, were common. Our cohort suggests there is no significant difference in the occurrence of anastomotic leakage, anastomotic stenosis or mortality rate between both treatments. There are a few considerations to take into account when interpreting the differences between both treatments. First of all, the incidences of complications following treatment for jejunoileal atresias in our cohort are in line with previous studies (3, 5, 7, 9). Secondly, previous studies suggested that low birthweight, prematurity, ASA score, cystic fibrosis, type of atresia and size of resection influences the occurrence of different complications (5, 7, 9). All of these assumed risk factors are equally distributed between
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