Minimal access approach to jejunal atresia

Jejunal atresia (JA) is a common cause of intestinal obstruction in the newborn. It is corrected by small bowel tapering/excision and end-to-end enteroenterostomy, performed through a transverse laparotomy incision. It has excellent result with minimal morbidity and mortality. This incision can be reduced to a circumumbilical type as has been described for hypertrophic pyloric stenosis.

Sixteen neonates, aged 1 to 8 days, underwent JA repair via this approach over a 3-year period.

The small bowel is easily accessible through this approach in all but 1 case, where a suspected colonic atresia, combined with JA, necessitated an extension to classical incision. Thirteen patients had an uneventful recovery; 2 cases required revision for anastomotic strictures, which was done through the same incision. Postoperative follow-up at 6 months showed well-healed skin incisions that were hardly visible and integrating well with the natural umbilical fold.

Circumumbilical incision permits an adequate approach to correction of JA. It has minimal complications and a superior cosmesis compared to the classical approach.