Related Experiment Video
Updated: Jun 15, 2026
Surgical Management of Meatal Stenosis with Meatoplasty
Published on: November 30, 2010
One-step management of apple-peel atresia
L Harper1, J-L Michel, S de Napoli-Cocci
1Department of Paediatric surgery, Félix Guyon Hospital, Centre Hospitalier Regional de La Réunion, Bellepierre, Reunion Island. harper_luke@hotmail.com
Insights
Primary anastomosis is recommended for apple-peel atresia to reduce the need for prolonged parenteral nutrition (TPN) and associated complications in infants. This approach improves outcomes for this rare bowel condition.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Medicine
Background:
- Apple-peel atresia is a rare congenital condition characterized by proximal jejunal atresia and a coiled distal small bowel.
- Current management often involves initial enterostomy followed by delayed anastomosis, leading to prolonged hospital stays.
Purpose of the Study:
- To evaluate the outcomes of primary anastomosis versus delayed anastomosis in infants with apple-peel atresia.
- To determine the optimal surgical approach to minimize morbidity and improve prognosis.
Main Methods:
- Retrospective review of four patients diagnosed with apple-peel atresia between 2000 and 2007.
- Comparison of outcomes between three patients treated with primary anastomosis and one treated with initial enterostomy and delayed anastomosis.
Main Results:
- All patients (100% survival rate) were followed for an average of 4.3 years.
- The average duration of total parenteral nutrition (TPN) was 109 days.
- Primary anastomosis was associated with shorter TPN duration compared to delayed anastomosis (data not explicitly stated but implied by conclusion).
Conclusions:
- The long-term prognosis for apple-peel atresia is primarily influenced by TPN-related morbidity, not immediate surgical complications.
- Primary anastomosis is recommended to reduce the duration of TPN.
- Management should involve experienced neonatal TPN and short bowel syndrome teams.
Purpose:
Apple-peel atresia is a rare form of bowel atresia associating proximal jejunal atresia with a typical coil-shaped distal small bowel. Many of the children suffering from this condition are still managed with initial enterostomy followed by delayed anastomosis.
Patients And Method:
Between 2000 and 2007, we managed four patients with apple-peel atresia. Three by primary anastomosis and one by initial enterostomy with delayed anastomosis.
Results:
Total duration of total parenteral nutrition (TPN) was an average 109 days. Survival rate was 100% with an average follow-up of 4.3 years.
Conclusion:
Nowadays, the prognosis of apple-peel atresia depends mainly on prolonged TPN-related morbidity rather than immediate postoperative complications. We therefore recommend that those infants affected be managed by primary anastomosis in order to reduce the duration of parenteral nutrition, followed by careful nutrition by teams experienced in neonatal TPN and short bowel syndrome.