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[Therapeutic effect of different surgical methods for congenital small intestine atresia]
1Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated hospital of Fujian Medical University, Fuzhou, 350001, China.
Insights
Proximal end-end anastomosis (PEA) is best for severe small intestine atresia cases with rapid recovery. End oblique anastomosis (EOA) is preferred for less severe cases, offering shorter hospital stays than end-to-end anastomosis (EEA).
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Congenital Malformations
Background:
- Small intestine atresia is a congenital condition requiring surgical intervention.
- Choosing the optimal surgical technique is crucial for patient outcomes.
- Previous studies have not definitively compared various anastomosis methods for different atresia severities.
Purpose of the Study:
- To compare the effectiveness of three surgical methods for treating small intestine atresia.
- To provide evidence-based recommendations for individualized surgical treatment in pediatric patients.
- To analyze outcomes based on the ratio of proximal to distal intestinal diameter.
Main Methods:
- Retrospective analysis of 168 pediatric patients with small intestine atresia (types II, III, IV).
- Patients were divided into three groups: end-to-end anastomosis (EEA), end oblique anastomosis (EOA), and proximal end-end anastomosis (PEA).
- Subgroup analysis based on the diameter ratio of the proximal to distal intestinal segments (≥4.0 vs. ≤4.0).
Main Results:
- No significant differences in demographic factors (gender, gestational age, birth weight) were observed.
- PEA showed superior outcomes in terms of postoperative defecation time, feeding time, hospital stay, and complications compared to EEA-a and EOA-a groups.
- EOA-a demonstrated better results than EEA-a for postoperative recovery and complications; EOA-b had a shorter hospital stay than EEA-b.
Conclusions:
- Proximal end-end anastomosis (PEA) is recommended for severe cases (proximal diameter >4x distal) due to faster recovery and fewer complications.
- End oblique anastomosis (EOA) is favored for less severe cases (proximal diameter ≤4x distal) over EEA, offering a shorter hospital stay.
- Individualized surgical approaches based on specific patient conditions are essential for optimal outcomes in congenital intestinal atresia.
Abstract:
Objective: To compare and analyze the curative effect of three surgical methods in the treatment of small intestine atresia, and to provide evidence for individualized surgical treatment of children with small intestine atresia. Methods: The clinical diagnosis and treatment of 168 children with small intestine Ⅱ, Ⅲ, Ⅳ type atresia in our hospital from January 2008 to September 2017 were retrospectively analyzed and they were divided into different types according to the operation. The three groups were end-to-end anastomosis group (EEA, n=58), end oblique anastomosis group (EOA, n=68), and proximal end-end anastomosis group (PEA, n=42). The EEA group and the EOA group were further divided into group a (EEA-a/EOA-a) with a proximal intestinal tube diameter greater than 4.0 times the distal end and a group b ((EEA-b/EOA-b) with a diameter less than or equal to 4.0 times the distal intestinal tube diameter. The gender, gestational age, birth weight, type of atresia, and postoperative defecation time, postoperative feeding time, postoperative hospital stay and postoperative follow-up complications were compared. Results: There was no significant difference in gender, gestational age and birth weight between the groups (P>0.05). The PEA group was better than EEA-a group and EOA-a group in postoperative defecation time, postoperative feeding time, postoperative hospital stay and complications (P<0.05). The postoperative defecation time, postoperative feeding time, postoperative hospital stay and complications of the EOA-a group were better than those of the EEA-a group (P<0.05). There was no statistically significant difference in postoperative defecation time, postoperative feeding time, and complications between the EEA-b group and the EOA-b group (P>0.05), but the postoperative hospital stay in the EEA-b group was longer than that in the EOA-b group (P<0.05). Conclusion: PEA is recommended for children with a proximal intestinal canal diameter greater than 4.0 times greater than the distal end because of the rapid recovery and fewer complications; EOA is recommended for children with a proximal intestinal canal diameter of 4.0 or less because of its advantage of shorter hospital stay than EEA surgery. Congenital intestinal atresia has a better effect according to the specific conditions of the child.
