P1.074: Effect of Fundoplication on Anastomotic Stricture in Patients with Esophageal Atresia-Tracheoesophageal Fistula

Background: A significant proportion of children with esophageal atresia with or without tracheoesophageal fistula (EA-TEF) experience gastroesophageal reflux disease (GERD), and many require fundoplication to manage their symptoms. Although GERD has been implicated in the development of anastomotic strictures, data are limited on whether fundoplication prevents strictures or if outcomes vary by the type of fundoplication performed.

Methods: Electronic medical record data of patients < 18 yo who underwent EA-TEF repair and fundoplication at a single institution from 1/1/2013 to 12/31/2024 were retrospectively reviewed. Demographics, surgical reports, and esophagogastroduodenoscopy (EGD) results within 2 years of fundoplication were collected and analyzed.

Results: A total of 203 children underwent EA-TEF repair. Of these, 31(15%) underwent fundoplication. The median age at fundoplication was 6.7 months, the median weight was 5.85 kg. Most patients (74.2%) had Type C EA-TEF (Table 1). Most fundoplications (67%) were done laparoscopically, with 3(9.7%) conversions to open. The most common indication was refractory GERD (87%). A complete fundoplication was performed in 13(41.9%) patients, while partial fundoplication was performed in 18(58.1%). There was no significant difference in age, weight, and type of EA-TEF between complete and partial fundoplication groups (Table 2).

An identical number of patients, 14(45.2%), had an anastomotic stricture before and after fundoplication. There were more pre-operative strictures in the partial compared to complete fundoplication group, 11(61.1%) vs 3(23.1%). Post-operative strictures occurred in 5(38.5%) patients after complete fundoplication, and in 9(50%) patients after partial fundoplication. Notably, all three children who underwent a complete fundoplication with a pre-existing stricture experienced persistent strictures post-operatively.

The rate of new stricture formation within 2 years was 3(16.7%) after partial fundoplication and 2(15.4%) after complete fundoplication. Five (16.1%) patients required re-operation for slipped (3 patients) and loosened fundoplication (2 patients). Of these, 3 had originally undergone a complete fundoplication, and 2 had a partial fundoplication. At re-operation, all 5 patients received a partial fundoplication, including the 3 that initially had a complete fundoplication. No patient required a second re-operation.

Conclusion: In our series of EA-TEF patients, fundoplication did not appear to affect the rate of anastomotic stricture resolution or prevention. Moreover, no differences were observed between complete and partial fundoplication with respect to stricture outcomes or re-operation rate.