Kathryn LaRusso
38 statements · 2 topics · summaries given as host listed separately
Featured statements
On multivariate analysis adjusting for gestational age, leak, long gap, anastomotic tension, and daily acid suppression, transanastomotic tubes conferred almost 3 times higher odds of developing a stricture compared to those without.
epidemiological ·
Esophageal Atresia
Transanastomotic feeding tubes are associated with an increased rate of postoperative strictures and decreased time to enteral feeding, but do not confer a major benefit in the number of days on postoperative TPN.
clinical ·
Esophageal Atresia
Risk factors for the development of post-operative stricture include anastomotic tension, long gap atresia, leak, gastroesophageal reflux, and more recently, trans anastomotic tubes have been implicated.
clinical ·
Tracheoesophageal Fistula
In the study data, only about 30 cases out of 244 patients were done thoracoscopically, which is insufficient to definitively determine whether MIS techniques impact stricture rates.
epidemiological ·
Tracheoesophageal Fistula
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Kathryn's statements about Esophageal Atresia 19 statements
Open the Esophageal Atresia collection →
APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso
Statement
Risk factors for the development of post-operative stricture include anastomotic tension, long gap atresia, leak, gastroesophageal reflux, and more recently, trans anastomotic tubes have been implicated.
Open
Statement
Use of transanastomotic tubes has increased since the 1980s, the rationale being a shorter time to feeds and a shorter duration of postoperative TPN.
Open
Statement
Due to recent studies implicating transanastomotic feeding tubes as an independent risk factor for strictures, Montreal Children's Hospital initiated a moratorium on their use until evaluating their own outcomes.
Open
Quotation
Our hypothesis was that was that transastomotic tubes increase the rate of postoperative strictures following EA and TEF repair.
Open
Statement
The study population included all type C and type D EA/TEF patients at three university-affiliated hospitals in Quebec over a 25-year period between 1993 and 2018.
Open
Statement
Inclusion criteria required primary repair within 6 months of birth and at least 1 year follow-up.
Open
Statement
Stricture was defined as symptoms with imaging confirmation by either upper GI or endoscopy at one year.
Open
Statement
Of 371 EA/TEF patients born during the study period, 344 were type C or D, and 244 were included in the final analysis.
Open
Statement
About 30% of patients had strictures, and transanastomotic tubes were used in 61% of patients.
Open
Statement
On univariate analysis, transanastomotic tubes were significantly associated with strictures.
Open
Statement
On multivariate analysis adjusting for gestational age, leak, long gap, anastomotic tension, and daily acid suppression, transanastomotic tubes conferred almost 3 times higher odds of developing a stricture compared to those without.
Open
Statement
Days on postoperative TPN were the same between groups with and without transanastomotic tubes.
Open
Statement
Days to first enteral feeding were shorter in the transanastomotic feeding tube group than those without.
Open
Statement
Transanastomotic feeding tubes are associated with an increased rate of postoperative strictures and decreased time to enteral feeding, but do not confer a major benefit in the number of days on postoperative TPN.
Open
Statement
In the study data, only about 30 cases out of 244 patients were done thoracoscopically, which is insufficient to definitively determine whether MIS techniques impact stricture rates.
Open
Statement
One standard type of tube was used as the transanastomotic feeding tube in the study.
Open
Statement
Data on replacement tubes when children fail oral feeding is difficult to analyze retrospectively and needs to be captured in future prospective studies.
Open
Statement
Transanastomotic tubes potentially increase inflammation and acid exposure to the anastomosis, which may increase stricture rates overall.
Open
Kathryn's statements about Tracheoesophageal Fistula 19 statements
Open the Tracheoesophageal Fistula collection →
APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso
Statement
Risk factors for the development of post-operative stricture include anastomotic tension, long gap atresia, leak, gastroesophageal reflux, and more recently, trans anastomotic tubes have been implicated.
Open
Statement
Use of transanastomotic tubes has increased since the 1980s, the rationale being a shorter time to feeds and a shorter duration of postoperative TPN.
Open
Statement
Due to recent studies implicating transanastomotic feeding tubes as an independent risk factor for strictures, Montreal Children's Hospital initiated a moratorium on their use until evaluating their own outcomes.
Open
Quotation
Our hypothesis was that was that transastomotic tubes increase the rate of postoperative strictures following EA and TEF repair.
Open
Statement
The study population included all type C and type D EA/TEF patients at three university-affiliated hospitals in Quebec over a 25-year period between 1993 and 2018.
Open
Statement
Inclusion criteria required primary repair within 6 months of birth and at least 1 year follow-up.
Open
Statement
Stricture was defined as symptoms with imaging confirmation by either upper GI or endoscopy at one year.
Open
Statement
Of 371 EA/TEF patients born during the study period, 344 were type C or D, and 244 were included in the final analysis.
Open
Statement
About 30% of patients had strictures, and transanastomotic tubes were used in 61% of patients.
Open
Statement
On univariate analysis, transanastomotic tubes were significantly associated with strictures.
Open
Statement
On multivariate analysis adjusting for gestational age, leak, long gap, anastomotic tension, and daily acid suppression, transanastomotic tubes conferred almost 3 times higher odds of developing a stricture compared to those without.
Open
Statement
Days on postoperative TPN were the same between groups with and without transanastomotic tubes.
Open
Statement
Days to first enteral feeding were shorter in the transanastomotic feeding tube group than those without.
Open
Statement
Transanastomotic feeding tubes are associated with an increased rate of postoperative strictures and decreased time to enteral feeding, but do not confer a major benefit in the number of days on postoperative TPN.
Open
Statement
In the study data, only about 30 cases out of 244 patients were done thoracoscopically, which is insufficient to definitively determine whether MIS techniques impact stricture rates.
Open
Statement
One standard type of tube was used as the transanastomotic feeding tube in the study.
Open
Statement
Data on replacement tubes when children fail oral feeding is difficult to analyze retrospectively and needs to be captured in future prospective studies.
Open
Statement
Transanastomotic tubes potentially increase inflammation and acid exposure to the anastomosis, which may increase stricture rates overall.
Open
Summaries Kathryn gave as host · 4 summaries
Recaps of other experts' statements, not Kathryn's own clinical position.
Summaries Kathryn gave as host · Esophageal Atresia 2 summaries
Open the Esophageal Atresia collection →
APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso
Host summary
Kathryn LaRusso summarizes what Dr. Miguel Guelfand said: A recent study from the Midwest Pediatric Surgery Consortium, looking at 292 patients with only type C EA/TEF, found an increased rate of strictures in the transanastomotic tube group that was almost 2 times that of those without.
Open
Host summary
Kathryn LaRusso summarizes what Dr. Miguel Guelfand said: A study from the Children's Hospital of Pittsburgh, looking at EA/TEF all types (majority type C), also found a significant difference in stricture rates between groups with and without transanastomotic tubes.
Open
Summaries Kathryn gave as host · Tracheoesophageal Fistula 2 summaries
Open the Tracheoesophageal Fistula collection →
APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso
Host summary
Kathryn LaRusso summarizes what Dr. Miguel Guelfand said: A recent study from the Midwest Pediatric Surgery Consortium, looking at 292 patients with only type C EA/TEF, found an increased rate of strictures in the transanastomotic tube group that was almost 2 times that of those without.
Open
Host summary
Kathryn LaRusso summarizes what Dr. Miguel Guelfand said: A study from the Children's Hospital of Pittsburgh, looking at EA/TEF all types (majority type C), also found a significant difference in stricture rates between groups with and without transanastomotic tubes.
Open