Laparoscope-assisted intestinal lengthening using an anterior flap in jejunal atresia.

Abstract

Jejunal atresia with short bowel syndrome is an unusual type of jejunoileal atresia. They present with jejunal atresia near the ligament of Treitz and a foreshortened small bowel. In this paper, we report our preliminary experience to emphasize the advantages and feasibility of enteroplasty for intestinal lengthening and primary anastomosis with an anterior flap in jejunal atresia with short bowel syndrome in neonates. Between January 2014 and December 2014, four neonates with jejunal atresia and short bowel syndrome were submitted to this procedure in our hospital. Enteroplasty for intestinal lengthening procedures was accomplished in all the neonates by laparoscopic-assisted procedure. The procedure was manually performed after exteriorization of the atretic bowel via the slightly enlarged umbilical port site incision. The mean operative time was 80min (range 65-110min). Blood loss was minimal. There was no mortality or surgical complication so far. The median follow-up duration was 14.5months (range 9-20months). In all the cases, the autonomy for oral/enteric feeding was obtained within 1month after surgery. One neonate was readmitted because of associated cholestasis 1month after the operation, and was cured by conservative therapy. Enteroplasty for intestinal lengthening and primary anastomosis with an anterior flap is a safe and feasible technique that could allow increased tolerance to oral/enteric feeding, thereby improves their chances for quality survival.