Enteral reduction and oblique anastomosis

Abstract

Background: Jejunoileal atresias are major causes of neonatal intestinal obstruction, and various surgical techniques were described for their treatment. Resection and/or tapering of the proximal dilated pouch and end-toend or end-to-back enteral anastomosis are the most commonly used techniques. Either of these techniques, however, has shortcomings such as loss of bowel length, kink obstruction, and anastomotic leak due to anastomotic line mismatch. Objective: The aim of this study was to describe an alternative surgical technique for bowel atresia repair, enteral reduction and oblique anastomosis. Patients and methods: The technique involves reduction of the dilated bowel diameter by removing an elliptical fullthickness part of the anterior wall of the proximal dilated pouch and oblique anastomosis of the resultant window with a longitudinally incised posterior wall of the distal bowel. Results: This technique was used in seven successive neonates, four female and three male, in 1 year. Their ages at operation ranged between 2 and 30 days (median 3 days). Six neonates recovered well. Enteral feeds were tolerated in 7–10 days and the length of hospital stay ranged between 15 and 36 days. One baby, who underwent surgical repair at the age of 30 days, died following severe sepsis and anastomotic leak. Conclusion: Enteral reduction and oblique anastomosis is an easy and safe alternative to current surgical techniques used for the treatment of small intestinal atresia. No bowel resection is required while proximal bowel tapering is achieved. Keywords: oblique anastomosis, small bowel atresia, tapering