Minimal access approach to jejunal atresia

Area of Science:

• Pediatric Surgery
• Neonatal Surgery
• Surgical Oncology

Background:

• Jejunal atresia (JA) is a frequent cause of intestinal obstruction in neonates.
• Current surgical correction involves small bowel tapering/excision and end-to-end enteroenterostomy via a transverse laparotomy.
• This standard approach yields excellent outcomes with low morbidity and mortality.

Purpose of the Study:

• To evaluate the efficacy and cosmetic outcomes of using a circumumbilical incision for jejunal atresia repair.
• To determine if a circumumbilical incision provides adequate surgical access for neonatal jejunal atresia correction.
• To compare the complication rates and cosmetic results of the circumumbilical approach versus the traditional transverse laparotomy.

Main Methods:

• A retrospective review of 16 neonates aged 1-8 days who underwent jejunal atresia repair using a circumumbilical incision over a 3-year period.
• Surgical technique involved small bowel tapering/excision and end-to-end enteroenterostomy.
• Assessment of surgical accessibility, intraoperative findings, postoperative recovery, complications, and long-term cosmetic results.

Main Results:

• The circumumbilical incision provided adequate surgical access in 15 out of 16 cases.
• One case required extension of the incision due to suspected coexisting colonic atresia.
• Thirteen patients experienced an uneventful recovery; two required revision for anastomotic strictures, managed through the same incision. Postoperative follow-up at 6 months revealed well-healed, minimally visible scars.
• The circumumbilical approach demonstrated minimal complications and superior cosmetic results compared to the classical transverse laparotomy.

Conclusions:

• The circumumbilical incision is a viable and effective surgical approach for the correction of jejunal atresia in neonates.
• This technique offers adequate exposure, minimal complications, and superior cosmetic outcomes, making it a favorable alternative to the traditional transverse laparotomy.
• The circumumbilical approach facilitates excellent wound healing and scar integration, enhancing patient cosmesis.