Efficacy of bowel plication for high jejunal atresia in neonates

Abstract

Objective To evaluate the efficacy of bowel plication as a part of surgical treatment in neonatal high jejunal atresia. Methods Between January 2013 and December 2016, 43 neonates with high jejunal atresia were operated. According to the specific surgical procedures, they were divided into bowel plication (n=18) and control (n=25) groups. The bowel plication group underwent proximal bowel plication after resecting atretic segments and primary anastomosis. The control group underwent enteroplasty after resecting atretic segments. The relevant data included gestational age, birth weight, concomitant diseases, age at surgery, operative duration, length of total parenteral nutrition (TPN), postoperative recovery of intestinal function (time of initial oral feeding and oral feeding volume reaching 40 ml/3 h), length of hospital stay, growth & development, complications and reoperations were retrospectively analyzed. Results No inter-group differences existed in gestational age, birth weight, concomitant diseases, age at surgery and operative duration. The time of initial oral feeding, time of oral feeding volume reaching 40 ml·kg-1·3 h-1 and TPN length of bowel plication group were shorter than those of control group [(9.4±3.1), (14.6±2.3), (9.2±2.7) vs. (13.5±2.6), (17.6±2.8), (14.3±2.4) days, P<0.05]. The length of hospital stay of bowel plication group were significantly shorter than those of control group [(15.3±3.1) vs. (18.5±3.6) days, P<0.05]. In bowel plication group, 1 (5.6%) underwent reoperation for intestinal stenosis after neonatal necrotizing enterocolitis at 1 year after initial operation. However, in control group, 3(12%) were re-operated for anastomotic stenosis and 2 for adhesive intestinal obstruction. The average follow-up period was 2.8 (0.5-4.5) years. All infants thrived and there were no inter-group differences in growth & development. Conclusions Additional bowel plication after atretic segment resection and primary anastomosis improves the clinical outcomes for neonates with high jejunal atresia. Key words: Intestinal atresia; Intestinal obstruction; Neonate