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Primary versus secondary anastomosis in intestinal atresia

Margot M Hillyer1, Katherine J Baxter1, Matthew S Clifton1

  • 1Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.

Journal of Pediatric Surgery
|June 9, 2018
PubMed

Insights

Primary anastomosis (PA) offers better outcomes for neonates with intestinal atresia (IA) than secondary anastomosis (SA). Surgeon preference significantly influences procedure choice, impacting patient recovery.

Area of Science:

  • Pediatric Surgery
  • Neonatal Care
  • Gastrointestinal Surgery

Background:

  • Neonates with intestinal atresia (IA) require surgical intervention.
  • Two primary surgical approaches exist: primary anastomosis (PA) and ostomy creation with secondary anastomosis (SA).

Purpose of the Study:

  • To compare the clinical outcomes of PA versus SA in neonates with IA.
  • To identify factors influencing the selection between PA and SA.

Main Methods:

  • Retrospective cohort study of 92 neonates with IA (2009-2015).
  • Analysis of patient characteristics, operative details, and outcomes.
  • Logistic regression used to assess surgeon-level preferences.

Main Results:

  • PA (76.1%) was more common than SA (23.9%).
  • PA associated with shorter hospitalizations, reduced parenteral nutrition duration, and fewer readmissions compared to SA.
  • Higher Apgar scores and uncomplicated atresia favored PA; surgeon preference varied widely and was independent of patient factors.

Conclusions:

  • Primary anastomosis demonstrates superior outcomes for neonates with intestinal atresia.
  • While neonate's clinical status influences procedural choice, surgeon preference plays a substantial role.
Abstract

Keywords:
Intestinal atresiaSurgical outcomes

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