Stapled intestinal anastomosis in neonates and infants: use of the endoscopic intestinal stapler

Stapled anastomoses of the gastrointestinal tract, commonplace in adults and older children, are rarely performed in newborns because of the size of the instruments. The development of smaller stapling devices for laparoscopic and thoracoscopic procedures presented an opportunity to evaluate the efficacy of such anastomoses in neonates and infants. Over an 11-month period, seven newborn or young infants underwent stapled functional end-to-end small or large intestinal anastomoses using the Endo-GIA 30. The male:female ratio was 3:4, and the mean age was 72d (range, 1 to 134 days). The mean weight at the time of the stapled anastomosis was 3.7 kg (range, 1.88 to 6.6 kg). The clinical setting requiring the intestinal anastomoses included ileostomy closure after perforated necrotizing enterocolitis (3), intestinal atresia (1), distal ileal volvulus (1), left colon mesenteric cyst (1), and biliary atresia (1). There were no deaths or anastomotic leaks. Nasogastric decompression was discontinued at a mean of 6 days (range, 3 to 11 days), and oral feedings were begun at a mean of 7.0 days (range, 4 to 12 days). The patients were discharged from the hospital 7 to 117 days after the operation (mean, 33 days). The endoscopic stapling instrument is safe and effective in performing small and large intestinal anastomoses in newborns and young infants.