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Primary anastomosis in apple-peel bowel syndrome
R R Turnock1, R J Brereton, L Spitz
1Department of Paediatric Surgery, Hospitals for Sick Children, London, England.
Insights
Primary anastomosis for apple-peel bowel in infants leads to shorter hospital stays and reduced need for parenteral nutrition compared to initial enterostomy. All patients survived, highlighting improved outcomes with primary anastomosis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Apple-peel bowel is a rare congenital anomaly characterized by a unique form of intestinal atresia.
- Management strategies for apple-peel bowel have evolved, with surgical intervention being critical for survival.
Purpose of the Study:
- To compare the outcomes of primary anastomosis versus initial enterostomy with delayed anastomosis in infants diagnosed with apple-peel bowel.
- To evaluate the impact of surgical approach on parenteral nutrition requirements and length of hospital stay.
Main Methods:
- Retrospective review of 12 infants with apple-peel bowel treated over a 15-year period.
- Comparison of two surgical techniques: initial enterostomy with delayed anastomosis (n=4) and primary anastomosis (n=8).
- Assessment of outcomes including need for parenteral nutrition and duration of hospitalization.
Main Results:
- Infants undergoing primary anastomosis had a significantly lower requirement for parenteral nutrition (6/8) compared to the enterostomy group (4/4).
- Primary anastomosis group experienced shorter hospitalizations (7/8 < 50 days) versus the enterostomy group (70-175 days).
- All 12 infants survived, with one case in the primary anastomosis group experiencing prolonged hospitalization due to short-bowel syndrome.
Conclusions:
- Primary anastomosis appears to be a more favorable surgical approach for managing apple-peel bowel in infants.
- This approach is associated with reduced morbidity, including decreased reliance on parenteral nutrition and shorter hospital stays.
- Surgical technique significantly impacts short-term outcomes in neonates with this rare intestinal anomaly.
Abstract:
During a 15-year period, 12 infants with apple-peel bowel were treated; the first 4 by initial enterostomy with delayed anastomosis and the remaining 8 by primary anastomosis. All four infants in the enterostomy group required parenteral nutrition, compared with only six of the eight who had a primary anastomosis. Seven of the eight infants treated by primary anastomosis were in hospital for less than 50 days, (however, the remaining child was an in-patient for over 2 years, but did suffer from short-bowel syndrome with only 17 cm of small intestine). In comparison, all four of the enterostomy group were hospitalised for between 70 and 175 days. All twelve patients survived.