{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:08:41Z","timestamp":1777532921623,"version":"3.51.4"},"reference-count":24,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T00:00:00Z","timestamp":1693440000000},"content-version":"unspecified","delay-in-days":30,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["World Jnl Ped Surgery"],"accepted":{"date-parts":[[2023,6,26]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Little is known about intestinal anastomotic leakage and stenosis in young children (\u22643 years of age). The purpose of this study is to answer the following questions: (1) what is the incidence of anastomotic stenosis and leakage in infants? (2) which surgical diseases entail the highest incidence of anastomotic stenosis and leakage? (3) what are perioperative factors associated with anastomotic stenosis and leakage?<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients who underwent an intestinal anastomosis during primary abdominal surgery in our tertiary referral centre between 1998 and 2018 were retrospectively included. Both general incidence and incidence per disease of anastomotic complications were determined. Technical risk factors (location and type of anastomosis, mode of suturing, and suture resorption time) were evaluated by multivariate Cox regression for anastomotic stenosis. Gender and American Society of Anaesthesiology (ASA) score of \u2265III were evaluated by \u03c7<jats:sup>2<\/jats:sup> test for anastomotic leakage.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 477 patients underwent an anastomosis. The most prominent diseases are intestinal atresia (30%), Hirschsprung\u2019s disease (29%), and necrotizing enterocolitis (14%). Anastomotic stenosis developed in 7% (34\/468) of the patients with highest occurrence in necrotizing enterocolitis (14%, 9\/65). Colonic anastomosis was associated with an increased risk of anastomotic stenosis (hazard ratio (HR) =3.6, 95%\u2009CI 1.8 to 7.5). No technical features (type of anastomosis, suture resorption time and mode of suturing) were significantly associated with stenosis development. Anastomotic leakage developed in 5% (22\/477) of the patients, with the highest occurrence in patients with intestinal atresia (6%, 9\/143). An ASA score of \u2265III (p=0.03) and male gender (p=0.03) were significantly associated with anastomotic leakage.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Both anastomotic stenosis and leakage are major surgical complications. Identifying more patient specific factors can result in better treatment selection, which should not solely be based on the type of disease.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/wjps-2023-000565","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T12:45:06Z","timestamp":1693485906000},"page":"e000565","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1069-7062","authenticated-orcid":false,"given":"Laurens D.","family":"Eeftinck Schattenkerk","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gijsbert D.","family":"Musters","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wouter J.","family":"de Jonge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.W. (Ernest)","family":"van Heurn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joep PM","family":"Derikx","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,8,31]]},"reference":[{"key":"2025081809532829000_6.4.e000565.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2006.10.001"},{"key":"2025081809532829000_6.4.e000565.2","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000013140","article-title":"STROBE-anastomotic leakage after pull-through procedure for hirschsprung disease","volume":"97","author":"Peng","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"2025081809532829000_6.4.e000565.3","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1016\/j.jpedsurg.2021.01.018","article-title":"The incidence of abdominal surgical site infections after abdominal birth defects surgery in infants: a systematic review with meta-analysis","volume":"56","author":"Eeftinck Schattenkerk","year":"2021","journal-title":"J Pediatr Surg"},{"key":"2025081809532829000_6.4.e000565.4","first-page":"127","article-title":"The incidence of different forms of Ileus following surgery for abdominal birth defects in infants: a systematic review with a meta-analysis method","volume":"6","author":"Eeftinck Schattenkerk","year":"2021","journal-title":"Innov Surg Sci"},{"key":"2025081809532829000_6.4.e000565.5","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/j.jpedsurg.2003.12.016","article-title":"Morbidity and mortality of colostomy and its closure in children","volume":"39","author":"Chandramouli","year":"2004","journal-title":"J Pediatr Surg"},{"key":"2025081809532829000_6.4.e000565.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-019-1488-5","article-title":"Enterostomy complications in necrotizing enterocolitis (NEC) surgery, a retrospective chart review at Odense University hospital","volume":"19","author":"B\u00e6lum","year":"2019","journal-title":"BMC Pediatr"},{"key":"2025081809532829000_6.4.e000565.7","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1016\/j.jpedsurg.2021.01.037","article-title":"Incisional hernia after abdominal surgery in infants: a retrospective analysis of incidence and risk factors","volume":"56","author":"Eeftinck Schattenkerk","year":"2021","journal-title":"J Pediatr Surg"},{"key":"2025081809532829000_6.4.e000565.8","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/codi.13476","article-title":"Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17 518 patients","volume":"19","author":"Parthasarathy","year":"2017","journal-title":"Colorectal Dis"},{"key":"2025081809532829000_6.4.e000565.9","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.yasu.2016.03.011","article-title":"Prevention of perioperative anastomotic healing complications: anastomotic Stricture and anastomotic leak","volume":"50","author":"Guyton","year":"2016","journal-title":"Adv Surg"},{"key":"2025081809532829000_6.4.e000565.10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.21037\/tp.2016.08.02","article-title":"Intestinal anastomosis in children: it\u2019s time for a general consensus","volume":"6","author":"Boscarelli","year":"2017","journal-title":"Transl Pediatr"},{"key":"2025081809532829000_6.4.e000565.11","unstructured":"Castor EDC . Castor electronic data capture. 2019. Available: https:\/\/castoredc.com [Accessed 27 Aug 2019]."},{"key":"2025081809532829000_6.4.e000565.12","doi-asserted-by":"crossref","first-page":"3293","DOI":"10.3748\/wjg.v26.i23.3293","article-title":"Consensus on the definition of colorectal anastomotic leakage: a modified Delphi study","volume":"26","author":"van Helsdingen","year":"2020","journal-title":"World J Gastroenterol"},{"key":"2025081809532829000_6.4.e000565.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2009.10.012"},{"key":"2025081809532829000_6.4.e000565.14","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.1990.258.6.G856"},{"key":"2025081809532829000_6.4.e000565.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12876-015-0410-3","article-title":"Colorectal anastomotic healing: why the biological processes that lead to anastomotic leakage should be revealed prior to conducting intervention studies","volume":"15","author":"Bosmans","year":"2015","journal-title":"BMC Gastroenterol"},{"key":"2025081809532829000_6.4.e000565.16","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/SLA.0000000000001131","article-title":"The human colon is more resistant to ischemia-reperfusion-induced tissue damage than the small intestine: an observational study","volume":"262","author":"Hundscheid","year":"2015","journal-title":"Ann Surg"},{"key":"2025081809532829000_6.4.e000565.17","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1055\/s-0033-1333635","article-title":"Are routine dilatations necessary post pull-through surgery for Hirschsprung disease","volume":"23","author":"Aworanti","year":"2013","journal-title":"Eur J Pediatr Surg"},{"key":"2025081809532829000_6.4.e000565.18","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1053\/j.sempedsurg.2012.07.011","article-title":"Reoperative surgery for hirschsprung disease","volume":"21","author":"Ralls","year":"2012","journal-title":"Semin Pediatr Surg"},{"key":"2025081809532829000_6.4.e000565.19","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s00383-012-3092-8","article-title":"Primary anastomosis in necrotizing enterocolitis: the first option to consider","volume":"28","author":"Guelfand","year":"2012","journal-title":"Pediatr Surg Int"},{"key":"2025081809532829000_6.4.e000565.20","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1097\/SLA.0000000000003167","article-title":"Females are more resistant to ischemia-reperfusion-induced intestinal injury than males: a human study","volume":"272","author":"Hundscheid","year":"2020","journal-title":"Ann Surg"},{"key":"2025081809532829000_6.4.e000565.21","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2007.053959"},{"key":"2025081809532829000_6.4.e000565.22","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jpedsurg.2010.09.076","article-title":"Experience performing 64 consecutive stapled intestinal anastomoses in small children and infants","volume":"46","author":"Mitchell","year":"2011","journal-title":"J Pediatr Surg"},{"key":"2025081809532829000_6.4.e000565.23","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1016\/j.jpedsurg.2008.08.052","article-title":"Stapled intestinal anastomoses in infants","volume":"43","author":"Wrighton","year":"2008","journal-title":"J Pediatr Surg"},{"key":"2025081809532829000_6.4.e000565.24","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1055\/s-2006-923995","article-title":"Technical problems and complications of a transanal pull-through for hirschsprung\u2019s disease","volume":"16","author":"Podevin","year":"2006","journal-title":"Eur J Pediatr Surg"}],"container-title":["World Journal of Pediatric Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/wjps-2023-000565","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T16:53:37Z","timestamp":1755536017000},"score":1,"resource":{"primary":{"URL":"https:\/\/wjps.bmj.com\/lookup\/doi\/10.1136\/wjps-2023-000565"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,8,31]]},"published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1136\/wjps-2023-000565"],"URL":"https:\/\/doi.org\/10.1136\/wjps-2023-000565","relation":{},"ISSN":["2516-5410"],"issn-type":[{"value":"2516-5410","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8]]}}}