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Purpose <p>Esophageal anastomotic leak (AL) is a serious complication following pediatric esophageal repair. The purpose of this study was to identify AL predictors and develop a risk-stratified guide to post-operative imaging.</p> Methods <p>A retrospective single-center cohort study of children who underwent a post-operative esophagogram following esophageal repairs from 2018 to 2023 and at risk for AL was conducted.</p> Results <p>A total of 285 esophageal repairs were performed on 256 children (median age 6.3 months). Seventeen leaks (6%) were identified and esophagograms were completed at a median of 9 days post-operative. Seven factors significantly associated with AL were identified in the univariate analysis: female sex, rescue Foker procedure, indocyanine green segmental esophageal hypoperfusion, suture line hypoperfusion, presence of a new moderate/large pneumothorax, a new moderate/large lung consolidation, and fever occurring 48&#xa0;h prior to an esophagogram. Multivariable analysis identified three independent predictors: segmental hypoperfusion, presence of a new moderate/large pneumothorax, or a new moderate/large lung consolidation. Predicted probability of AL was 3%, 14%, 74%, and 90% for 0, 1, 2, and all 3 predictors present, respectively.</p> Conclusion <p>Findings from this study highlight the potential for post-operative imaging to have an individualized approach based on objective predictors of AL.</p>

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Predictors of anastomotic leak and a risk-stratified approach to post-operative esophagograms in pediatric esophageal repair

  • 期刊论文

  • 发表日期：

    2026年7月10日

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  • Rebecca Leslie-Roberts,
  • Ethan Schuler,
  • Alexandra Cole,
  • Steven J. Staffa,
  • David Zurakowski,
  • Debra Lajoie,
  • Michele DeGrazia,
  • Benjamin Zendejas

摘要

Purpose

Esophageal anastomotic leak (AL) is a serious complication following pediatric esophageal repair. The purpose of this study was to identify AL predictors and develop a risk-stratified guide to post-operative imaging.

Methods

A retrospective single-center cohort study of children who underwent a post-operative esophagogram following esophageal repairs from 2018 to 2023 and at risk for AL was conducted.

Results

A total of 285 esophageal repairs were performed on 256 children (median age 6.3 months). Seventeen leaks (6%) were identified and esophagograms were completed at a median of 9 days post-operative. Seven factors significantly associated with AL were identified in the univariate analysis: female sex, rescue Foker procedure, indocyanine green segmental esophageal hypoperfusion, suture line hypoperfusion, presence of a new moderate/large pneumothorax, a new moderate/large lung consolidation, and fever occurring 48 h prior to an esophagogram. Multivariable analysis identified three independent predictors: segmental hypoperfusion, presence of a new moderate/large pneumothorax, or a new moderate/large lung consolidation. Predicted probability of AL was 3%, 14%, 74%, and 90% for 0, 1, 2, and all 3 predictors present, respectively.

Conclusion

Findings from this study highlight the potential for post-operative imaging to have an individualized approach based on objective predictors of AL.