Abstract
The author presents an overview of the current trends in acute neonatal gastrointestinal surgery. Necrotizing enterocolitis and focal intestinal perforation are disorders of different etiology, appearance, and prognosis. In neonates with focal perforation, a good prognosis can be expected. Primary anastomosis is a valid option for primary surgery. Meconium ileus is based on obstruction of the terminal ileum. Medical treatment is the primary therapeutic option, although surgery may be required. In contrast, meconium plug syndrome is based on stool plugging in the left colon, and surgery is not appropriate. Hirschsprung’s disease is confirmed on the basis of representative biopsy of the rectum just above the dentate line. There is a trend toward a single-step pull-through operation without protective stoma. Open hernia repair in small neonates can be performed via a mini-incision and without opening the external inguinal ring. Laparoscopic hernia repair has some advantages, especially in girls. In infants with pyloric stenosis, laparoscopic pyloromyotomy is a first line option for treatment. There is a general trend toward single-stage procedures and laparoscopic reconstructive surgery for gastrointestinal malformations. With the exception of tracheoesophageal fistula and low bowel obstruction, the vast majority of upper gastrointestinal malformations can be identified using prenatal ultrasound examination. One-stage repair with excellent results is even possible in neonates below 1000 g. Surgery of duodenal or small bowel atresia can be performed following the postnatal adaptation period. For some forms of anorectal malformation, the need for a protective stoma has been questioned in the last decade. Posterior sagittal anorectoplasty remains the standard procedure for the majority of cases. Midgut or segmental volvulus affects different groups of infants. If a neonate is suspected of having any type of volvulus, urgent surgery is required. Intestinal duplication carries a high risk for complications, and surgery should be performed on an elective basis.
Highlights
Congenital and acquired diseases of the gastrointestinal tract are predominantly rare diseases, with prevalences between 1:300 and 1:10,000 or less
Meconium ileus is based on obstruction of the terminal ileum
We are faced with a particular problem where there is aganglionia associated with type-B intestinal neural dysplasia (IND), occurring in up to 40% of cases [25]
Summary
Congenital and acquired diseases of the gastrointestinal tract are predominantly rare diseases, with prevalences between 1:300 and 1:10,000 or less. The overview presented is based on the literature and experience. In this respect, meta-analyses and international surveys provide important information. Prospective randomized multi-institutional studies promise the highest-level evidence but are not feasible to address many of these questions for ethical reasons. Summary presentations in recent years have shown substantial progress in pediatric surgery, and they form the basis of this review [1] [2] [3] [4]. The present study is predominantly in line with evidence levels 3 and 4 and, in the case of empirical values or expert opinions, with level 5
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
