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Abstract
Background: This study was undertaken to review the Bishop–Koop procedure as a treatment option with a grossly dilated proximal segment in jejunal and proximal ileal atresia.Materials and Methods: This was a retrospective cohort study conducted from January 2012 to June 2018 in the Department of Pediatric Surgery at King George's Medical University, Lucknow, India. The outcome, complication rate, and the follow-up study for postoperative adverse outcomes were assessed.Results: Thirty-two neonates underwent Bishop–Koop procedure. The mean age at presentation was 4.37 2.3 days. The male (n=22) to female (n=10) ratio was 2.2:1. Sixteeen had jejunal (type II-9, type III- 7), and 16 (type II-6, type III-10) had proximal ileal atresia. The mean duration of the hospital stay was 13.03 5.7 days. Oral feeds were initiated by the 7th postoperative day. In our study, the complication rate was 31.25% (n=10) and mortality rate was 37.5% (n=12).Conclusions: Bishop–Koop procedure appears to be a technically efficient method in desperate cases of jejunoileal atresia with a grossly dilated proximal segment, although more extensive studies may be needed to compare Bishop–Koop procedure and other operation techniques.
Highlights
The choice of surgery in jejunoileal atresia depends on the pathologic findings and specific set of circumstances encountered in an individual case
Some prefer resection of the proximal dilated atretic segment back to the level where the diameter of the intestine approaches 1 to 1.5 cm in ileal atresia, or near the ligament of Treitz in jejunal atresia followed by primary anastomosis
This study aimed to review Bishop–Koop procedure as a treatment option in jejunal and proximal ileal atresia, where primary anastomosis was not deemed feasible due to gross proximal bowel dilatation
Summary
The choice of surgery in jejunoileal atresia depends on the pathologic findings and specific set of circumstances encountered in an individual case. Most authors prefer an oblique anastomosis after resection of dilated proximal atretic segment up to 10-15 cm.[1,2] Some prefer resection of the proximal dilated atretic segment back to the level where the diameter of the intestine approaches 1 to 1.5 cm in ileal atresia, or near the ligament of Treitz in jejunal atresia followed by primary anastomosis. The outcome in such cases depends upon meticulous postoperative neonatal intensive care, prevention of sepsis, and Total Parenteral Nutrition (TPN). Conclusions: Bishop–Koop procedure appears to be a technically efficient method in desperate cases of jejunoileal atresia with a grossly dilated proximal segment, more extensive studies may be needed to compare Bishop–Koop procedure and other operation techniques
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