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Abstract
Aim: To review nine-year experience in managing jejuno-ileal atresia (JIA) by primary resection and anastomosis and identify factors associated with reoperations.Methods: From April 2006 to May 2015, all consecutive neonates who underwent bowel resection and primary anastomosis for JIA were analyzed retrospectively. Patients with temporary enterostomy were excluded. Patient demographics, types of atresia, surgical techniques, need for reoperations, and long-term outcomes were investigated. Results: A total of forty-three neonates were included, in which nineteen (44.2%) of them were preterm and fourteen (32.6%) were of low birth weight. Thirteen patients (30.2%) had jejunal atresia whereas thirty patients (69.8%) had ileal atresia. Volvulus, intussusception and meconium peritonitis were noted in 12, 8, and13 patients, respectively. Eight patients (18.6%) had short bowel syndrome after operation. Ten patients (23.3%) required reoperations from 18 days to 4 months after the initial surgery due to anastomotic stricture (n=1), adhesive intestinal obstruction (n=1), small bowel perforation (n=2) and functional obstruction (n=6). Prematurity and low birth weight were associated with functional obstruction leading to reoperation (p=0.04 and 0.01 respectively). The overall long-term survival was 97.7%. All surviving patients achieved enteral autonomy and catch-up growth at a median follow-up of 4.7 years.Conclusion: Long-term survival of JIA after primary resection and anastomosis are excellent. However, patients have substantial risk of early reoperations to tackle intraabdominal complications.
Highlights
Jejunoileal atresia (JIA) is a major cause of neonatal intestinal obstruction, with an incidence ranging from 1.3 to 2.9 per 10,000 live births[1,2,3].With advancement of neonatal intensive care, anesthesia, parenteral nutrition and operative techniques, the survival figure was reported to be around 80% in 1990s [4] and further climbed to more than 90% in the 21st century [1,5]
We reviewed our experience in managing patients with congenital JIA over a 9-year period and analyzed the long-term outcomes after proximal bowel resection with primary anastomosis and the factors associated with reoperation
Fortythree patients (87.8%) who had primary repair by resection of proximal atretic segment with primary anastomosis were included in the study whereas six patients who underwent enterostomy were excluded
Summary
Jejunoileal atresia (JIA) is a major cause of neonatal intestinal obstruction, with an incidence ranging from 1.3 to 2.9 per 10,000 live births[1,2,3].With advancement of neonatal intensive care, anesthesia, parenteral nutrition and operative techniques, the survival figure was reported to be around 80% in 1990s [4] and further climbed to more than 90% in the 21st century [1,5]. The operative management depends on the site of the atresia, the specific anatomical findings, associated gastrointestinal tract anomalies and the length of the remaining small bowel. A temporary enterostomy, is necessary in less favorable conditions with doubtful vascular integrity of bowel, significant intraperitoneal contamination by meconium peritonitis, and excessive discrepancy in the diameter between the distal.
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