[Treatment of intestinal atresia]

Thirteen cases of intestinal atresia are described: 9 jejunal and 4 ileal. The duration of pregnancy was significantly shorter and the birthweight significantly lower in jejunal than in ileal atresia. The proximal intestine was strongly dilated in 8/9 cases with jejunal atresia. This group also contains several complex and extended varieties of atresia. The postoperative mortality was 8%. Gastrointestinal functional disturbances occurred only in the group treated for jejunal atresia. These disturbances were temporary and occurred postoperatively in 2 cases but reoperation was mandatory in another 2 cases, once without functional success. There were no problems in the other cases. Ileal atresia is easy to treat and the result is always good. In contrast, the situation is much more challenging in cases of jejunal atresia: prematurity, higher incidence of complex and extended gastrointestinal malformations, impossibility to resect the dilated proximal segment, presence of a long under-developed distal segment. No problems have been observed after construction of a double stoma and restoration of the intestinal continuity. However a proximal stoma leads to important fluid and electrolyte losses, necessitating total parenteral nutrition. Functional gastrointestinal disturbances are frequently observed after end-to-side anastomosis in Y with mucous fistula. An end-to-end anastomosis can be combined with enteroplasty of the proximal distended bowel segment, eventually including the duodenum. Although the enteroplasty technique is an important progress in the treatment of neonates with extended types of jejunal atresia, transit problems cannot always be prevented by this procedure.