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Intestinal atresia: factors affecting survival
Insights
Congenital atresia outcomes improved significantly over time. Factors like other congenital abnormalities and malrotation increase mortality risk, with primary anastomosis without a stoma recommended.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Neonatal Care
Background:
- Congenital atresia of the jejunum, ileum, or colon presents a significant surgical challenge in neonates.
- Historically, treatment outcomes for these conditions have varied, necessitating investigation into contributing factors.
Purpose of the Study:
- To analyze factors influencing mortality in patients with congenital jejuno-ileal or colonic atresia.
- To identify trends in outcomes over a 25-year period and provide recommendations for surgical management.
Main Methods:
- Retrospective study of 84 patients with jejuno-ileal or colonic atresia treated between 1961 and 1986.
- Multivariate linear modeling to identify factors associated with fatal outcomes.
- Analysis of surgical techniques, including anastomosis type and bowel resection length.
Main Results:
- Overall mortality decreased from 56% in the first 15 years to 22% in the last 10 years.
- Factors significantly associated with increased mortality include the presence of other congenital abnormalities, malrotation, and the type of anastomosis (stoma associated with higher mortality).
- Patients with 60 cm or less of remaining small bowel had a poor survival rate (3/11).
Conclusions:
- Surgical management of congenital atresia has improved, reflected in reduced mortality rates.
- Congenital abnormalities and malrotation are critical risk factors for mortality.
- A primary anastomosis without a stoma is recommended to improve patient survival.
Abstract:
Eighty-four patients with congenital jejuno-ileal or colonic atresia treated at this hospital during the years 1961-86 were studied. There were 42 cases of jejunal atresia, seven cases of jejuno-ileal atresia, 33 cases of ileal atresia and two cases of colonic atresia. Multiple atresias occurred in 19 patients. During the first 15 years of the study the mortality rate was 56%. In the last 10 years it was 22%. Multivariate linear modelling techniques were used to determine the factors associated with a fatal outcome. In order of magnitude associations were found between death and year of treatment (P less than 0.01), the type of anastomosis performed to correct the atresis (P less than 0.05), the presence of other congenital abnormalities (P less than 0.01) and presence of a malrotation (P less than 0.02). The anastomoses associated with the highest mortality were those with a stoma. The mean length of bowel resected proximal to the anastomosis was 15 cm and the mean length resected distally 5 cm. Eleven patients had 60 cm or less of small bowel remaining after surgery and only three of these survived. The highest mortality rate can be expected in patients with other congenital abnormalities and those with a malrotation. A primary anastomosis without a stoma is recommended.