What are risk factors for anti-reflux surgery after esophageal atresia repair?

We've been working with the literature team from the Chilean Society of Pediatric Surgeons to hunt down articles relevant to pediatric surgery beyond JPS. With their help, we chose to highlight a few articles this month focused on the for gut. So Alex Kasar found an interesting article published in the Journal of Pediatrics. Alex, you want to dive into that one? So this article was really interesting. It came from France and it includes results from 38 different hospitals. They established an esophageal atresia registry. And so it's a population based study in which they followed over 800 kids for a year. But pretty much what they evaluated was the factors that contributed to them having a fundoplication or any anti-reflux surgery by one year of age. They found three main factors that contributed in the perioperative aspect. And those were anastomotic tension at the time of the operation, associated malformations and then birth weight. For any increase in Z score in birth weight, the chance that they got an anti-reflux procedure is decreased. How did they measure or quantify tension that some cases had more or less tension during the cases? Was it just something they looked through the up note? That was my number one question and they actually don't specify it in the paper. And it's one person's tension, I mean they're always under a little bit of tension, so one person's tension is subjective to another. So I would say that I think it's I agree with you, I think it's good that there was so many patients in the study. I'm not exactly sure what I learned from it to affect my practice, uh but it's an interesting paper. Hopefully they'll have some great data on long-term outcomes on 800 patients, 600 patients is a pretty significant substantial population. It'd be interesting to see if they study them far enough out to assess the incidence of Barretts. They did mention that they would focus on Barretts and esophagitis and like adult reflux and a whole bunch of other things in their long-term outcomes.