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Jejunoileal atresia: a 27-year experience
S Sato1, E Nishijima, T Muraji
1Kobe Children's Hospital, Japan.
Insights
Surgical strategies for jejunoileal atresia (JIA) in 88 neonates focused on preserving bowel length. An end-to-end single-layer anastomosis technique led to early functional recovery, avoiding short bowel syndrome.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Neonatal Care
Background:
- Jejunoileal atresia (JIA) is a congenital obstruction requiring surgical intervention.
- Optimal surgical techniques aim to maximize bowel length and function post-repair.
- Short bowel syndrome is a significant long-term complication of extensive bowel resection.
Purpose of the Study:
- To evaluate the surgical treatment strategy for jejunoileal atresia (JIA).
- To assess the impact of different surgical approaches on patient outcomes.
- To determine the effectiveness of bowel-preserving techniques and anastomosis methods.
Main Methods:
- Retrospective review of 88 neonates with JIA undergoing surgical repair.
- Classification of JIA into four groups based on lesion type: membranous, interrupted, multiple, and apple-peel.
- Application of a uniform surgical protocol emphasizing bowel length preservation and single-layer end-to-end anastomosis.
Main Results:
- Three operative-unrelated deaths occurred among 88 patients.
- Early oral feeding was achieved by day 5.4±4.3, with full enteric intake by day 12.5±10.0.
- No patients required long-term management for short bowel syndrome, highlighting successful bowel length preservation.
Conclusions:
- Efforts to preserve bowel length in JIA surgery are crucial for preventing short bowel syndrome.
- A single-layer end-to-end anastomosis technique facilitates early recovery of bowel function.
- The evaluated surgical strategy demonstrates efficacy in managing JIA and improving neonatal outcomes.
Purpose:
In this study, the authors review cases of jejunoileal atresia (JIA) to evaluate their surgical treatment strategy.
Methods:
Eighty-eight neonates who underwent surgical repair for JIA were divided into four groups for the type of lesion: group 1, membranous (n = 23), group II, interrupted (n = 49), group III, multiple (n = 9), and group IV, apple-peel (n = 7). Group I patients were treated with membranectomy or bowel resection and anastomosis, group II with resection of the dilated bowel and one anastomosis, group III with two to six multiple anastomoses to preserve bowel length, and group IV with minimal bowel resection and bowel anastomosis. During surgery a uniform protocol was used to minimize bowel resection and to perform an end-to-end single layer anastomosis using either Halsted horizontal mattress or conventional interrupted sutures. Mortality, morbidity, days for functional recovery, and central venous nutrition (CVN) were included in the review.
Results:
Of 88 patients, three died of causes unrelated to operation for JIA. Nine patients underwent an additional laparotomy for leakage (n = 4) and obstruction (n = 5). Oral feeding was allowed on day 5.4+/-4.3 and full caloric intake via the enteric route on day 12.5+/-10.0. Twenty-one patients required CVN for 32.4+/-19.1 days. None required a long-term treatment for the short bowel syndrome.
Conclusion:
This study concludes that efforts to preserve bowel length are laudable to avoid the short bowel syndrome and that an end-to-end single layer anastomosis contributes to early recovery of bowel function.