Bishop-Koop Procedure Research Articles

EFFICACY OF BISHOP KOOP SURGERY IN NEONATES WITH JEJUNOILEAL ATRESIA – A SINGLE CENTER STUDY

Jejunoileal atresia is a significant congenital condition requiring surgical intervention. The Bishop Koop procedure has been a notable technique for managing this condition, yet comprehensive evaluations of its efficacy and safety are needed to validate its continued use. Objective: To evaluate the effectiveness of the Bishop Koop procedure in managing jejunoileal atresia. Methods: This cross-sectional study was conducted at the Department of Pediatric Surgery, The Children's Hospital, PIMS Islamabad, from July 2023 to April 2024. Forty-two patients diagnosed with jejunoileal atresia were clinically evaluated and underwent the Bishop Koop procedure. Post-operative outcomes, including the duration of surgery, time to initiate bowel movements and feeding, and early complications, were recorded. Patients were followed up during their hospital stay to record outcomes of discharge or expiry. SPSS version 29.0 was utilized to identify mortality predictors. All patients received postoperative intravenous antibiotics. Results: Of the 42 neonates treated, 66.7% were successfully discharged, while 33.3% expired, indicating a significant rate of adverse outcomes. The study provides detailed data on surgical durations, recovery times, and complication rates. Conclusion: The findings suggest that the Bishop Koop procedure is a safe and effective surgical option for severe jejunoileal atresia despite the substantial proportion of adverse outcomes. Further studies are warranted to optimize patient selection and procedural techniques to enhance survival rates.

The Success of the Bishop-Koop Surgery in Newborns with Meconium Ileus and Congenital Intestinal Atresia When Compared to Divided Stomas

Objective: The purpose of this study is to compare the Bishop-Koop procedure (BK) to the divided stoma in newborns with meconium ileus (MI) and congenital intestinal atresia. Study Design: Retrospective study Place and Duration: Children Hospital PIMS.Dec-2021-Jun 2022 Methods: There were seventy six neonates were presented in this study. Included neonates had meconium ileus (MI) and congenital intestinal atresia (CIA) and admitted to Hospital for surgery. Pateints were equally divided in two groups. Group I received divided stoma (DS) among 38 neonates and group II received Bishop-Koop procedure (BK) in 38 cases. Outcomes among both groups were compared in terms of surgery time, complications, and hospital stay. Mean standard deviation was used for data presentation. Results: There were 42 males (21 in each group) and 34 female (17 in each group) neonates among all cases. Mean age of the neonates in group I was 8.5 ± 4.16 days. Meconium ileus was found in 21(55.3%) in group I and 20 (52.6%) in group II and the rest of the neonates among both groups had congenital intestinal atresia. Mean operative time in group I was higher 180.7 ±9. 34 minutes as compared to group II 110.3 ± 7.26 minutes. We found that hospitalization in group II was lower 3.11 ±5. 40 days as compared to group I 10.2± 9.17 days. Frequency of complications in group I was higher found in 8 (21.5%) cases as compared to group II in 4 (10.5%) cases. Conclusion: In comparison to DS ostomies, we came to the conclusion that the BK approach is a safe, dependable, and acceptable technique for newborn surgery with a low risk of complications and shorter operating time and duration of hospital stay after ostomy closure. Keywords: Divided Stoma, Bishop-Koop, Meconium ileus , Congenital Intestinal Atresia, Complications

Bishop Koop procedure in Hirschsprung disease in a two year old child: Case report

Abstract The Hirschsprung disease characterised by congenital absence of ganglion cells, is confirmed by sero muscluar biopsies of the involved bowel, hence the initial leveling colostomy/ileostomy followed by subsequent definitive pull through procedure. However only the full circumference of the pulled down bowel having ganglion cells in all four quadrants is confirmatory. Histopathological disparity, differences or errors in diagnosis can arise in both sero muscular and full circumference full thickness biopsy samples, challenging the surgeon in further management of the these children; such a rare case has been described here with is its successful surgical management. Bishop koop procedure classically described in meconium ileus can be attempted in such confusing cases before contemplating major surgical intervention.

Role of Bishop–Koop Procedure for Jejunal and Proximal Ileal Atresia

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.

Comparison of outcomes following three surgical techniques for patients with severe jejunoileal atresia.

BackgroundSevere jejunoileal atresia is associated with prolonged parenteral nutrition, higher mortality and secondary surgery. However, the ideal surgical management of this condition remains controversial. This study aimed to compare the outcomes of patients with severe jejunoileal atresia treated by three different procedures.MethodsFrom January 2007 to December 2016, 105 neonates with severe jejunoileal atresia were retrospectively reviewed. Of these, 42 patients (40.0%) underwent the Bishop–Koop procedure (BK group), 49 (46.7%) underwent primary anastomosis (PA group) and 14 (13.3%) underwent Mikulicz double-barreled ileostomy (DB group). Demographics, treatment and outcomes including mortality, morbidity and nutrition status were reviewed and were compared among the three groups.ResultsThe total mortality rate was 6.7%, showing no statistical difference among the three groups (P = 0.164). The BK group had the lowest post-operative complication rate (33.3% vs 65.3% for the PA group and 71.4% for the DB group, P = 0.003) and re-operation rate (4.8% vs 38.8% for the PA group and 14.3% for the DB group, P < 0.001). Compared with the BK group, the PA group showed a positive correlation with the complication rate and re-operation rate, with an odds ratio of 4.15 [95% confidence interval (CI): 1.57, 10.96] and 12.78 (95% CI: 2.58, 63.29), respectively. The DB group showed a positive correlation with the complication rate when compared with the BK group, with an odds ratio of 7.73 (95% CI: 1.67, 35.72). The weight-for-age Z-score at stoma closure was –1.22 (95% CI: –1.91, –0.54) in the BK group and –2.84 (95% CI: –4.28, –1.40) in the DB group (P = 0.039). ConclusionsThe Bishop–Koop procedure for severe jejunoileal atresia had a low complication rate and re-operation rate, and the nutrition status at stoma closure was superior to double-barreled enterostomy. The Bishop–Koop procedure seems to be an appropriate choice for severe jejunoileal atresia.

Management of Meconium Ileus: 5 years' experience at Dhaka Shishu (Children) Hospital

Background : Meconium ileus (MI) is one of the common cause of intestinal obstruction in neonate. It can be present with various complications (about 50%) like volvulus, atresia, and gangrene of the gut, perforation and meconium cyst.&#x0D; Objective : This study aimed to compare various surgical procedures used in the treatment of meconium ileus and to assess their efficacy regarding survival and complications in our center.&#x0D; Methods : This retrospective study was done to all cases of meconium ileus admitted in the Department of neonatal surgery of Dhaka Shishu (Children) Hospital during the past 5 years (2011 to2016). The medical records of all patients with meconium ileus were studied. The surgical procedures were Mikulicz procedure, Bishop-Koop procedure done in case of complicated cases and Mikulicz procedure, Bishop-Koop and T tube ileostomy done in uncomplicated cases. Outcomes were compared between complicated and uncomplicated group and between the surgical procedures.&#x0D; Results : Total patients were 224. Among them 8 were excluded due to incomplete data. The mean age was 3.23 days. Twenty four neonates were preterm. Fifty-two percent were uncomplicatedMI and 48.15% were complicated. Among 112 uncomplicated cases, Mikulicz procedure done in 33 cases, Bishop-Koop procedure done in 37 cases and rest were treated by T tube ileostomy procedures. Among 104 cases of complicated meconium ileus, Mikulicz procedure done in 75 cases and 42 cases were treated by Bishop-Koop stoma. Predominant complications in Mikulicz procedures were high output fistula (67.6%), sepsis (34.84%) and skin excoriation (58.33%), while in Bishop-Koop procedure were sepsis (59.25%), anastomotic leak and reoperation (25.75%). In T tube ileostomy, complications were intra-peritoneal leak with reoperation and sepsis (9.52%). Twenty five (11.6%) stoma prolapse were found in Mikulicz ileostomy. The overall mortality of meconium ileus was 36.6%, in simple MI 23 out of 112 and in complicated MI 56 out of 104. This difference was significant.&#x0D; Conclusion : Considering the study result we concluded that complications occur more frequently in Mikulicz procedure and it is significantly associated with mortality, Bishop- Koop ileostomy can be considered but anastomotic leak is still an important complication of this procedure. In uncomplicated cases T tube ileostomy found as the best option.&#x0D; Northern International Medical College Journal Vol.10(1) Jul 2018: 326-329

Recent Change in Management Pattern of Meconium Ileus at Dhaka Shishu Hospital

Background : Meconium Ileus (MI) accounting for 9–33% of neonatal intestinal obstruction and one of the common cause of intestinal obstruction in neonate. Near about 50% can be present with various complications. Options for surgical management of MI include resection of dilated ileum with primary anastomosis, Bishop–Koop ileostomy, Santulli procedure or Mikulicz procedure and T tube ileostomy. In our center, before January 2015, mostly Mikulicz and few Bishop- Koop procedures were done for MI. But, the complications were high. From 2015, we started to perform T tube ileostomy and Bishop-Koop procedure in simple MI. In complicated cases Mikulicz and Bishop-Koop procedure were done and the scenario changed. This study was done to compare the outcome of MI surgery before and after January 2015.Methods: This was a retrospective study done in our center during January 2011 to December, 2016 (5 years). All cases were divided into two groups (Group-A: January 2011 to December 2014 and in Group-B: January 2015 to December 2016). Demographic data and surgical outcomes were compared.Results: Total 216 cases were included, in Group-A: 123 patients and others were in Group- B. Simple MI were 49% in Group-A and 56% were in Group-B. Complicated MI presented with small gut volvulus (43.3%) gangrene of loaded ileum (32.2%) perforation with peritonitis (37.8%) intestinal atresia with adhesions (16.3%) and meconium pseudocysts in 12 cases (16%). 11 patients had more than one complication. All the postoperative complications were found significantly high in Group-A except anastomotic leakage. Mortality was also significantly high in Group-A.Conclusion: Morbidity and mortality were significantly reduced with increasing practice of T tube ileostomy and Bishop-Koop procedure in simple and complicated Meconium ileus.Chatt Maa Shi Hosp Med Coll J; Vol.16 (2); July 2017; Page 5-8

Is the Bishop–Koop procedure useful in severe jejunoileal atresia?

PurposeThe aim of this study was to report our experience using the Bishop–Koop procedure for the treatment of various surgical problems of jejunoileal atresia including luminal discrepancy, complex meconium peritonitis, type IIIb and type IV atresia which we defined as severe jejunoileal atresia. MethodsThis retrospective study was performed on the patients with severe jejunoileal atresia who underwent Bishop–Koop procedure at a tertiary center in China over a five year of period. The mortality, complication rate, nutrition status and the risk factors for postoperative adverse outcomes were explored. ResultsA total of 41 neonates underwent the Bishop–Koop procedure. The median duration of the hospital stay and total parenteral nutrition and the point at which oral feeding was initiated postoperatively were 24 days (95% CI =18.99–29.01), 13 days (95% CI = 9.03–16.97) and 11 days (95% CI = 10.17–11.83) respectively. The mortality rate was 7.32% (3/41). The complication rate was 41.4% (17/41) including anastomotic leak, intestinal obstruction, high output stoma and cholestasis. The weight for age Z-score at stoma closure was restored to normal levels (−0.86, 95% confidence interval (CI) = −1.44, −0.28). The main factor associated with adverse outcomes in severe jejunoileal atresia was premature delivery (odds ratio (OR) = 4.44, 95% CI = 1.06–18.67). ConclusionsBishop–Koop procedure appears to be a technically efficient method for severe jejunoileal atresia, although larger studies are needed to compare Bishop–Koop procedure and other operation techniques. Type of studyTherapeutic. Level of evidenceLevel IV.

MECONIUM ILEUS; A STUDY AND COMPARISON BETWEEN COMMON OPERATIVE PROCEDURES PERFORMED IN BASRAH

Meconium ileus accounts for 9–33% of all neonatal intestinal obstructions, with an incidence of 1:2500 newborns, representing the third most common cause of neonatal small bowel obstruction after atresia and malrotation. This study aimed to compare various surgical procedures used in the treatment of meconium ileus and to assess their efficacy regarding survival and complications. A retrospective study was done to all cases of meconium ileus admitted to the neonatal intensive care unit of Basrah hospital of maternity and children and Basrah children specialty hospital during the period of 10 years (2005 to 2015). The medical records of 57 cases of meconium ileus were studied. The comparison included: Mikulicz procedure, Bishop-Koop procedure and resection with primary anastomosis in both simple and complex meconium ileus. The parameters used for comparison were anastomotic leaks, high output diarrhea with dehydration and failure to thrive, sepsis, need for reoperation, wound complications, early adhesions, hospital stay and mortality. The mean age of presentation of neonates with meconium ileus was 3.9 days. Male to female ratio was 0.9: 1. About 10.5% were preterm. About 33.3% of cases were diagnosed as simple meconium ileus. Intestinal Volvulus is the predominant complications encountered (47.4%). Non-operative treatment was effective in 45.5%. The most common procedures done in our center were Mikulicz procedure (61.5%), followed by Bishop-Koop procedure (30.8%), and resection with primary anastomosis (7.7%). There was a significant association between mortality and high output fistula, anastomotic leaks, sepsis, and reoperation. Predominant complications in Mikulicz procedures were high output fistula (50%) and skin excoriation (53.1%), while in Bishop-Koop procedure were sepsis (75%), reoperation (50%), and adhesions (25%). In primary anastomosis, significant complications were anastomotic leak (75%), sepsis (50%), and reoperation (50%). Mortality was highest in primary anastomosis (75%), followed by Bishop-Koop procedure (62.5%), and lowest with Mikulicz procedure (40.6%). The overall mortality of meconium ileus was high 45.6% (42.9% for simple meconium ileus and 52.6% for complex meconium ileus). All neonates treated non-operatively survived, while the survival rate for those treated surgically was 50%. In conclusion, resection with stoma creation is superior to primary anastomosis. Mikulicz procedure is the safest procedure to be done with best survival and less complications. Bishop- Koop procedure is of value in a situation where the surgeon is afraid from high output diarrhea so proximal stoma is mandatory.

Application of Bishop-Koop stoma in refractory congenital intestinal atresia

To explore the feasibility and safety of Bishop-Koop stoma procedure in the treatment of neonates with refractory congenital intestinal atresia. Clinical and follow-up data of 25 neonates with refractory congenital intestinal atresia undergoing Bishop-Koop stoma procedure in our center from January 2011 to December 2014 were retrospectively analyzed. Of 25 neonates, 13 (52%) were male, 12(48%) were female, the birth weight was 1600-3800 g (mean 2920 g), the age of admission was 10 hours to 20 days, and the age of operation was 1-58 d (mean 7 d). Diameter ratio of proximal atresia intestine to distal atresia intestine was all greater than 4. Eleven cases(44%) were high jejunal atresia, 3 cases(12%) type III( b, 7 cases(28%) type IIII(, 14 cases(56%) were identified as complex meconium peritonitis, and 3 cases (12%) received reoperation. All the cases completed their Bishop-Koop stoma operations successfully with median operative time of 3 (1.2-4.5) hours and median intra-operative blood loss of 3.5(1-18) ml. The postoperative complication rate was 20%(5/25), including 3 cases of cholestasis, 1 case of ileus, and 1 case of neonatal necrotizing enterocolitis with septicemia who died 6 days after operation resulting in the mortality of 4%. Besides, 1 case gave up treatment because of economic reason. For the rest 23 neonates, the median first feeding time was 11 days and mean time was 11(5 to 20) days; the median time of postoperative total parenteral nutrition (TPN) was 15 days and mean time was 21 (5 to 68) days; the median hospital stay was 33 days and mean hospital stay was 25(12 to 81) days, respectively. Two-stage stoma closure operations were performed in all the 23 cases afterwards and no postoperative associated complications were found. When discharge after Bishop-Koop stoma operations, Z score of body weight was normal in 3 cases(13.0%) and lower than normal in 20 cases(87.0%), while in hospitalization for stoma closure, Z score of body weight was normal in 19 cases(82.6%) and lower than normal in 4 cases (17.4%). Of 23 cases, serum albumin level was normal in 9 cases(39.1%) before operation, in 3 cases (13.0%) when discharge and in 22 cases(95.7%) in hospitalization for stoma closure. Bishop-Koop stoma procedure is safe and feasible in the treatment of neonates with refractory congenital intestinal atresia, and can obviously improve the nutritional status.

Bishop Koop Technique is Preferred than Primary Anastomosis in Managing Jejunoileal Atresia in a Setup without Neonatal Intensive Care Unit - Our Initial Experience

Background: Neonatal intestinal obstruction due to jejunoileal atresia is not uncommon. Recommended treatment is resection with end to back anastomosis and post operative care in Neonatal Intensive Care Unit (NICU) with Total Parenteral Nutrition (TPN) support. In a setup without NICU and TPN, mortality of primary anastomosis is very high due to unusual delay in starting enteral feeding. Bishop Koop technique seems to allow early oral feeding and rapid establishment of normal gastrointestinal function and thus reduce mortality and morbidity.Objective: To find out the outcome of Bishop Koop procedure in patients with Jejunoileal atresia.Methods: This is an ongoing study started from March, 2011 in the Department of Pediatric Surgery, Chittagong Medical College Hospital. Here we are presenting our initial experience till June, 2012 (duration of 16 months). During this period total 13 patients of uncomplicated Jejunoileal atresia was treated surgically. Four patients were treated by classical end to oblique anastomosis and all died. Rest of the 9 patients were treated by Bishop Koop technique. Overall outcome of this technique was assessed considering time to establish oral feeding and normal bowel movement, ceasation of coming distal stoma’s effluent, weight gain, death etc.Result: Out of 9 patients, 6 patients weighing less than 2.5 Kg. Type- III A was the commonest variant. Two patients died following surgery due to sepsis. Oral feeding was possible within 4-7 postoperative day in all survived patients except one. In follow up satisfactory weight gain was observed in all those patients.Conclusion: Bishop Koop technique could be considered as preferred surgical option in a set up without NICU and TPN.J. Paediatr. Surg. Bangladesh 3(1): 5-11, 2012 (January)

Early restoration of intestinal continuity in acute mesenteric ischaemia using Bishop–Koop stoma

Acute mesenteric ischaemia frequently requires extensive bowel resection. Primary anastomosis is unsafe necessitating exteriorisation of proximal small bowel and distal colon. Inevitably, therefore, patients are left with high output stomas with concomitant fluid and nutritional problems. We present two cases of acute mesenteric ischaemia both of which required extensive bowel resection. In both patients, we re-established intestinal continuity early by fashioning a Bishop-Koop type of reconstruction. Both patients had uneventful postoperative recoveries with no stoma-related complication or anastomosis problems. Neither patient required prolonged parenteral therapy. Bishop-Koop procedure may be used safely in a selected group of patients, with potential advantages of early restoration of intestinal continuity and easier closure.

Prognostic factors in jejuno-ileal atresia

Primarily to study morbidity and mortality in jejuno-ileal atresias (JIA) and prognostic factors for outcome. Secondarily to look at the incidence of reintervention. Retrospective review of 63 patients diagnosed with JIA over a 30-year period (1975-2005). Sixty-three patients (34 male) of mean gestational age 36 weeks and mean birth weight 2,858 g with JIA were studied. There were 14 type I, 14 type II, 16 type IIIA, 9 type IIIB, and 10 type IV atresias. Thirty-three patients (52%) had associated anomalies. Fifty-one patients underwent resection and anastamosis, five patients Bishop-Koop procedure, five ileostomies, and one strictureplasty. Intestinal dilatation severe enough to warrant surgical intervention was seen in seven patients with the more severe variants of atresia. Five tapering procedures, one Bianchi operation and one STEP procedure were performed. Average hospital stay was 41 days (8-332 days). Fifty-six were alive at follow ups averaging 1.7 years (6 months to 11 years). Nine patients needed reoperations for adhesions before the first year of life. There were seven deaths. Most patients who died had associated anomalies (P = 0.017) or types IV/V atresias (P = 0.007). Mild atresias have an excellent prognosis and long-term survival. Severe atresias are associated with longer PN support and secondary procedures for intestinal failure. Associated anomalies adversely affect outcomes in JIA.

Morbidity and mortality in small bowel atresia. Jejuno-ileal atresia.

One hundred and one babies were admitted to the Hospital for Sick Children, Great Ormond Street, London, between 1967 and 1981, suffering from small bowel atresia. The overall mortality in this period was 23%, although in the years 1974-81 this fell to 12%. Mortality was considerably higher in jejunal atresia than in ileal atresia. The improved survival in the second half of the series was related to more frequent use of parenteral nutrition. Morbidity and mortality following the Bishop-Koop procedure was high and this operation is inappropriate for the treatment of small bowel atresia.