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Stapled intestinal anastomoses with endoscopic staplers in premature infants
Colin Muncie1, Michael Morris1, Barry Berch1
1Division of Pediatric Surgery, University of Mississippi Medical Center, Jackson, MS.
Insights
In premature infants under 5kg, stapled intestinal anastomosis showed comparable safety and effectiveness to handsewn techniques. This study validates stapled methods for neonatal bowel surgery, reducing potential complications.
Area of Science:
- Neonatal surgery
- Surgical techniques
- Gastrointestinal surgery
Background:
- Intestinal anastomosis is common in neonates.
- Stapled techniques are well-documented in older patients but less validated in neonates.
- Handsewn anastomosis is the traditional method for premature infants.
Purpose of the Study:
- To compare the safety and effectiveness of stapled versus handsewn intestinal anastomosis in premature infants weighing less than 5kg.
- To evaluate anastomotic complications in neonates undergoing stapled bowel procedures.
Main Methods:
- Retrospective study of premature infants (<36 weeks gestational age, <5kg) undergoing intestinal anastomosis over 4 years.
- Collected data on patient demographics, anastomosis type, and complications within 3 months.
- Compared outcomes between handsewn and stapled anastomosis groups.
Main Results:
- 33 handsewn and 38 stapled anastomoses were performed in 65 infants.
- Groups differed in age, weight, and diagnosis.
- No significant differences in leak or stricture rates between stapled and handsewn groups.
- Higher incidence of blood per rectum in the stapled group (24% vs. 6%) did not reach statistical significance.
Conclusions:
- Stapled intestinal anastomosis is a safe and effective technique in premature infants weighing less than 5kg.
- No significant differences in major anastomotic complications were observed between stapled and handsewn techniques.
- Findings support the use of stapled anastomosis in this vulnerable patient population.
Purpose:
The safety and effectiveness of a stapled intestinal anastomosis in adults, children, and infants is well documented. However, in neonates it is not well validated. We hypothesized that premature infants who received a stapled bowel anastomosis utilizing endoscopic staplers had similar outcomes compared to patients with a handsewn anastomosis.
Methods:
A retrospective study was performed reviewing premature infants who underwent an intestinal anastomosis over a 4-year period. Patients greater than 36weeks gestational age at birth or a weight greater than 5kg at surgery were excluded. Patient demographics, type of intestinal anastomosis, and anastomotic related complications within 3months were collected and analyzed.
Results:
Sixty-five patients underwent 71 operations involving an intestinal anastomosis: 33 cases were handsewn, and 38 cases were stapled. Groups were noted to have differences in age, weight, and diagnosis. Complications including leak and anastomotic stricture did not differ between groups. Reports of blood per rectum after surgery were more common in the stapled group (24% versus 6%, p=0.0522), but this did not reach statistical significance.
Conclusion:
There were no significant differences in anastomotic complications when comparing the handsewn and stapled intestinal anastomosis techniques in premature infants weighting less than 5kg.
Type Of Study:
Treatment Study.
Level Of Evidence:
III.
