Jejunoileal atresia: A 27-year experience

Abstract

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 I, 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.