Small Bowel Atresia Research Articles

The Association Between Platelet Mass Index and Mechanical Ventilation in Pediatric Surgery Cases

Platelet mass index (PMI) is an indicator of platelet functionality. This study aimed to examine the relationship between PMI and mechanical ventilation need in infants less than 1 year of age who underwent gastrointestinal system surgery. We retrospectively reviewed the medical records of cases that underwent gastrointestinal surgery in the last 10 years (2010-2020) at Baskent University Konya Hospital. Demographic data, indications for surgery, age at surgery, preoperative blood tests, hospitalization times, discharge status, mechanical ventilation need and duration, sepsis, accompanying anomalies, recurrent surgery requirements were collected from patient records. The study group (n: 143) was divided into 2 groups as the need for mechanical ventilation (MV; n: 73) and the group that did not need mechanical ventilation (n-MV; n: 70). Data were analyzed with SPSS version 25. PMI was significantly lower in the MV group (1999 Vs 2798, p< .001). 65% of the cases were newborns. Mean gestational age was 34.5 ±4 weeks, and birth weight was 2100 ± 820 g. Most of the cases that need surgical intervention consist of small bowel atresia, esophageal atresia, surgeries due to necrotizing enterocolitis, and anal atresia. Ileus was present in 54% of the patients. The recurrent surgery requirement was 34%. The frequency of accompanying cardiac anomalies was 30.6%, and the rate of proven sepsis was 38.3%. Preoperative 2163 PMI value can discriminate not needing MV with 72% sensitivity and 69% specificity (AUC: .699, p<.001). When the basic characteristics of the groups were evaluated, 83% of the patients who underwent MV were in the newborn group. The birth weight, gestational age, hospital duration, oxygen exposure, culture-positive sepsis rates, total parenteral nutrition (TPN) rates, and duration were found to be significantly higher in patients who underwent MV. While there was no difference in the number of white blood cells in the preoperative blood analysis, the neutrophil-lymphocyte (N-L) ratio, platelet number, albumin values were significantly lower and CRP values were significantly higher in the MV group. There was no difference in the platelet –lymphocyte (PL) ratio. High PMI values can be used as a parameter to discriminate the need for mechanical ventilation

Laparoscopic Management of Congenital Intestinal Obstruction: Duodenal Atresia and Small Bowel Atresia.

Background: Congenital intestinal obstruction occurs in ∼1:2000 live births. Congenital duodenal atresia and duodenal stenosis are frequent causes of intestinal obstruction and occur in 1 per 5000-10,000 live births. Today, duodeno-duodeno anastomosis is still the treatment of choice, and it can be performed safely by minimally invasive surgery, although duodenojejunal anastomosis is surgically simpler and has equal results. Jejunum-ileal atresia or stenosis is a major cause of neonatal intestinal obstruction; its prevalence is 1:330-1:1500 live births. Nowadays, the ability of laparoscopic assisted identification of the atresia and repair by only exteriorization of the small bowel through the umbilicus makes this technique safe and feasible in almost every new born. Methods: This article will describe the operative technique of laparoscopic management of congenital duodenal and small bowel obstruction. Results: For congenital duodenal atresia patients, mortality rate is less than 5% and the majority are secondary to associated comorbidities. There is a low rate of anastomotic leaks, anastomotic stricture, delayed gastric emptying, and bacterial overgrowth. For small bowel atresia patients, complications include anastomotic leak, adhesions, small bowel obstruction, and short bowel syndrome in less than 5% of the patients. The rate of re-operations due to small bowel obstruction in laparoscopic assisted repair patients is less compared with laparotomy patients. Conclusions: Minimally invasive surgery for duodenal and small bowel atresia is safe and feasible and reduces the complications of open surgical procedures.

Mucous Fistula Refeeding Promotes Earlier Enteral Autonomy in Infants With Small Bowel Resection.

Infants requiring intestinal resection because of necrotizing enterocolitis (NEC) or small bowel atresia (SBA) may benefit from mucous fistula refeeding (MFR) of enterostomy output to improve nutrition and bowel adaptation before reanastomosis. Previous series demonstrated improved outcomes with MFR but did not account for varied patient characteristics as potential sources of bias. We performed a cohort analysis using multivariable adjusted models to compare outcomes of patients with and without MFR. Retrospective chart review was performed for patients with NEC or SBA and small bowel resection with enterostomy and MF. Demographic and outcome data was compared between MFR and non-MFR groups using adjusted multivariable analysis for potential confounding variables. MFR was performed in 65 of 101 patients (64%), including 45 of 75 patients with NEC and 20 of 26 patients with SBA. Reasons for not receiving MFR included bowel stricture, technical limitation, or not otherwise specified. NEC patients receiving MFR had 14 fewer days to achieve full enteral feeds after intestinal reconnection, 22 fewer days of parenteral nutrition, lower peak direct bilirubin by 2.4 mg/dL, and 77% less odds of ursodiol use (all P < 0.01). SBA patients had similar trends not reaching statistical significance. Growth parameters were improved in MFR groups. There were no complications or increased infections from MFR. This study suggests that MFR safely improves nutritional outcomes in infants with intestinal resection, related to decreased total parenteral nutrition (TPN) dependence and earlier enteral autonomy.

Atresias de intestino delgado. Revisión de la patología y hallazgos radiológicos asociados a distintos casos

Small-bowel atresias are among the most common causes of intestinal obstruction in newborns, and they often require urgent surgical treatment. Imaging techniques play a very important role in their diagnosis, which is often suspected on prenatal obstetric ultrasound and confirmed on postnatal plain-film X-rays. Abdominal ultrasound's lack of ionizing radiation, wide availability, low cost, and high resolution is making this technique increasingly important in confirming atresias and in detecting possible complications in newborns. This review analyzes a series of cases seen at our center. It summarizes the different types of small-bowel atresias, focusing on the clinical presentation, imaging findings on different modalities, presence of associated disease, management, clinical course, and outcomes.

A Comprehensive Review of Intestinal Atresias

A Comprehensive Review of Intestinal Atresias

Multiple Small Bowel Atresia: Resection or Conservation?

Multiple small bowel atresia is a relatively uncommon cause of intestinal obstruction in neonates. About one-third of the neonatal intestinal obstruction is caused by intestinal atresia. As suggested by Louw and Barnard, the vascular accident in utero is the principal reason, resulting in bowel atresia.1 The condition presents soon after birth, with bilious vomiting and abdominal distension, requiring emergency surgical intervention. A subtype of small bowel atresia (type IV), which presents with involvement of multiple segments, is unique due to the difficulties in management, accompanied by a variety of postoperative morbidities, which are highlighted in this case. The choice lies between resection of all the atretic segments with resultant single anastomosis and conservation with anastomoses of multiple small bowel segments involving meticulous repair by fine sutures, taking care to maintain luminal patency. The dilemma of whether to conserve the atretic segments of bowel, which is a time consuming procedure but preserves the bowel length or to proceed with excision of the atretic bowel segments, accepting the likelihood of short bowel, in order to provide a quick, safe and stable single anastomosis in a timely manner, is a valid challenge. The background of limited resource setting also need to be taken into consideration. Key Words: Atresia, Neonates, Bowel segments, Anastomosis.

Особливості клінічних проявів атрезії тонкої кишки в перші хвилини життя новонароджених дітей

Clinical signs of small bowel atresia, which are widely described in the literature, usually develop after the first day of life. Studies on the clinical manifestations of intestinal atresia in newborns in the first minutes of their lives are still lacking. Purpose — to identify clinical signs of different types of intestinal atresia which can be detected by physical examination of the newborn, immediately after birth. Materials and methods. A retrospective study of 77 newborns with congenital small intestinal obstruction (SIO) who underwent surgical management at the Neonatal Surgery Center for Congenital Malformations and their Rehabilitation SI «Institute of Pediatrics, Obstetrics and Gynecology named after acad. E.M. Lukyanova of the NAMS of Ukraine» was conducted. The clinical manifestations of SIO in patients with duodenal (n=44), jejunal (n=14) and ileal (n=19) atresia were studied and a statistical analysis was performed. Results. There was no significant difference in the volume of gastric stasis, abdominal bloating and meconium discharge in patients with different types of duodenal obstruction (P&gt;0.05). It was found that patients with duodenal and jejunal obstruction, immediately after birth, have a significantly higher volume of gastric stasis (38.0±23.9 ml and 42.3±20.0 ml, respectively) compared with patients who had ileal atresia (14.7±12.8 ml), (P&lt;0.05). There were no significant differences in the incidence of abdominal bloating and meconium discharge (P&gt;0.05). Conclusions. Duodenal and jejunal atresia are associated with excessive gastrostasis, but meconium discharge may be normal. Abdominal bloating always occurs in duodenal atresia and may be absent in jejunal and ileal atresia. In patients with ileal atresia, there may be no signs of intestinal obstruction immediately after birth. Level of evidence. Level III. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the child's parents was obtained from the studies. No conflict of interest was declared by the authors. Key words: atresia, small intestine, clinical manifestations, newborns.

Effect of Strict Lockdown on Pediatric Surgical Services and Residency Programme during COVID-19 Pandemic

OBJECTIVE: To document the measures adopted during the COVID-19 pandemic strict lockdown on pediatric surgical services and residents' training at a tertiary care hospital. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Department of Pediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, from April 2020 to June 2020. METHODOLOGY: Data from the Outpatient Department, Emergency Department, and Operation Theatre records were collected. The number of patients seen in the outpatient department, surgeries performed, index emergency cases dealt with, and the residents' duty roster and teaching methodology were documented. Descriptive statistics were used for reporting. RESULTS: During the strict lockdown period, outpatient services continued;however, elective cases were not operated. A total of 2,930 patients were seen in clinics, and 1,316 surgical procedures were performed. The index cases managed included anorectal malformation (n=35), esophageal atresia with and without tracheoesophageal fistula (n=13), small bowel atresia (n=11), omphalocele (n=6), acute appendicitis (n=35), intestinal obstructions (n=23), intussusceptions (n=18), and intestinal perforations (n=16). On-call days of residents were reduced from every third to the fifth day, and online educational sessions were added. During the pandemic, 13 members of surgical and anaesthesia teams got infected with COVID-19. CONCLUSION: COVID-19 pandemic elective surgical services were restricted;however, emergency cases were managed as per routine. In clinical teaching, virtual technologies were incorporated. Working hours of residents were limited to decrease the exposure to infected persons. Key Words: COVID-19, SARS-CoV-2 pandemic, Healthcare workers, Residency programme.

Effect of Strict Lockdown on Pediatric Surgical Services and Residency Programme during COVID-19 Pandemic.

To document the measures adopted during the COVID-19 pandemic strict lockdown on pediatric surgical services and residents' training at a tertiary care hospital. Cross-sectional descriptive study. Department of Pediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, from April 2020 to June 2020. Data from the Outpatient Department, Emergency Department, and Operation Theatre records were collected. The number of patients seen in the outpatient department, surgeries performed, index emergency cases dealt with, and the residents' duty roster and teaching methodology were documented. Descriptive statistics were used for reporting. During the strict lockdown period, outpatient services continued; however, elective cases were not operated. A total of 2,930 patients were seen in clinics, and 1,316 surgical procedures were performed. The index cases managed included anorectal malformation (n=35), esophageal atresia with and without tracheoesophageal fistula (n=13), small bowel atresia (n=11), omphalocele (n=6), acute appendicitis (n=35), intestinal obstructions (n=23), intussusceptions (n=18), and intestinal perforations (n=16). On-call days of residents were reduced from every third to the fifth day, and online educational sessions were added. During the pandemic, 13 members of surgical and anaesthesia teams got infected with COVID-19. COVID-19 pandemic elective surgical services were restricted; however, emergency cases were managed as per routine. In clinical teaching, virtual technologies were incorporated. Working hours of residents were limited to decrease the exposure to infected persons. Key Words: COVID-19, SARS-CoV-2 pandemic, Healthcare workers, Residency programme.

Хірургічне лікування атрезії тонкої кишки новонароджених за умов різного післяопераційного супроводу

Introduction. Small intestine atresia is one of the most common causes of low bowel obstruction in newborns. Mortality in this pathology ranges from 5 to 60%, depending on the country. Modern views about surgical correction are rather contradictory. Purpose. To analyze the surgical treatment of small intestine atresia in the surgical department of the City Children’s Hospital No. 1 ССH) (Chernivtsi, Ukraine) and the surgical department Saint Damien Pediatric Hospital NPH (SDH) (Port-o-Prence, Haiti). To determine the best methods of surgery. Materials and methods. The surgical treatment of 15 children under the conditions of SDH (Haiti) and 12 children under conditions of the city children’s clinical hospital (CCH, Chernivtsi) with atresia of the small intestine was analyzed. Determined the effectiveness of closed (oblique «end-to-end» anastomosis, taping with «end-to-end» anastomosis, Denis-Brown and Louw anastomoses), discharging (U- and T-shaped, taping with anostomosing and suspended proximal enterostoma), anastomoses and stomas (end, double, according to Mikulich). Mortality with limited parenteral nutrition was 40% (SDH), with the presence of parenteral nutrition – 33.33% (ССH, Chernivtsi). Results. According to the analyzed data, we believe that the use of the method of surgical treatment should correspond to the type of atresia, the distance of the blind proximal end from the Treitz ligament, the difference in the diameters of the adducting and abducting sections, the possibility of parenteral nutrition, and the threat of short bowel syndrome (SCS). Conclusions. Y-shaped discharging anastomosis «side-to-side» with the removal of the proximal area in the form of a stoma, can be the method of choice in case of significant difference between the intestinal diameters. It provides a wide area of the small bowel junction, chyme abduction until the fistula heals, and can be used for different types of small bowel atresia. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Keywords: small intestine atresia, surgical treatment, children.

Surgical treatment of newborns with small bowel atresia (literature review)

Intestinal atresia is a congenital obstruction of the lumen of the jejunum or ileum and is one of the most common causes of congenital obstruction in newborns. This literature review is devoted to the surgical treatment of newborns with various types intestinal atresia. Causes of intestinal atresia are considered, where a special role is assigned to the genetic theory, the expression of the nucleotide sequences ITGA2 873G/A and NPPA 2238T/C and antenatal circulatory disorders of the developing intestine. Topographical-anatomical and morphological characteristics of the intestine in newborns with intestinal atresia are studied in detail in articles. A table of revealed histomorphological features of the small intestine in children with atresia was compiled. In addition, processes occurring in the mucosa, submucosa, muscle, and serous membranes are described in detail. A relationship was found related to the size of the atresia site and duration of ischemia. The theory of neuromuscular regulation of the intestine is considered, in which an important role is assigned to interstitial pacemaker cells of Cajal. Variants of anastomosis depending on the difference in diameters of the adductor and excretory parts of the intestine are analyzed, and results of treatment in patients with laparoscopic access are described. The postoperative course of disease, development of complications, recurrent operative interventions, duration of parenteral nutrition, and onset of enteral load was evaluated.&#x0D; Conclusion. The choice of surgical technologies used to restore the patency of the intestinal tube is determined by the degree of discrepancy between diameters of anastomosed segments. The prognosis is not determined by tactics of surgical treatment, type of atresia, time before treatment, and presence of associated anomalies.

A female neonate with absent anal opening and dug perineum: Think high

Background: A female neonate with anorectal malformation (ARM) may have one, two, or three openings in the perineum. One opening represents cloaca while three openings usually suggest low ARM. Females with two openings in the perineum may be ARM without any fistula, rectovaginal fistula, or absent vagina. The association of ARM with multiple intestinal atresias and malrotation is rare. Case Presentation: We present here a case of a female neonate with two perineal openings, whose perineum was explored by a general surgeon without any radiological investigation and was later found to have a high ARM, multiple jejunal and ileal atresia with malrotation. Conclusion: ARM associated with small bowel atresia and malrotation are rarely described. Such cases require management in Pediatric surgery settings.

Double trouble with triple bubble: A rare case of double small bowel atresia in a neonate

We experienced a rare case of double small bowel atresia (SBA) at our centre. A premature baby boy was born at 35 weeks of gestation. Antenatal scans had already shown a grossly dilated stomach and bowel. Postnatal abdominal X-ray (AXR) showed a triple bubble sign. During emergency laparotomy, we found that there was a Type III atresia at the second part of duodenum and a Type I atresia at the duodenojejunal junction. Duodeno-duodenostomy, duodeno-jejunostomy, duodenal plication and appendicectomy were done. Post-operatively, he was fasted for almost two weeks due to persistently high nasogastric aspirates. However, with the help of prokinetic drugs, he was finally able to tolerate breast feeding and was discharged home well.

Ultrasound Guided Hydrostatic Treatment of Meconium Ileus; another Indication for Ultrasound Based Approach to Bowel Obstruction

Dear Editor-in-Chief, The inspissated meconium pellets are a cause or effect of ileocolic obstructions. The present study aimed at explaining our experience of ultrasound-based approach for differentiation and treatment of the inspissated meconium pellets. This study was conducted at Mashhad University of Medical Sciences, Mashhad, Iran, from 2017-2020. Twenty-four neonates (less than 8 days) with inspissated meconium pellets were examined using ultrasound. Moreover, in cases with non-complicated inspissated meconium pellets, ultrasound-guided contrast enema was performed for confirmation of the diagnosis or probable treatment. In ultrasound, the inspissated meconium pellets were observed as uniform hypo- to hyper-echoic tubular or beaded intra-luminal material in ileocolic loops or recto-sigmoid area. These pellets were in five states: simple meconium ileus, localized or generalized meconium, small bowel, meconium plug syndrome, and Hirschsprung's disease. During contrast enema in non-complicated meconium ileus, moving and floating of inspissated meconium pellets was observed during ultrasound scanning, while this issue was not observed in small bowel atresia. The success rates of the hypertonic contrast enema in patients with simple meconium ileus were 80%. The inspissated meconium pellets have an ultrasound appearance. They are mainly observed in patients with simple and complicated meconium obstructions and bowel atresia. Except in complicated meconium obstructions, the ultrasound-guided contrast enema was performed for their differentiation and probable treatment.

Efficacy and safety of parenteral vitamin D therapy in infants and children with vitamin D deficiency caused by intestinal malabsorption.

PurposeOral supplementation of vitamin D can be inefficient in patients with vitamin D deficiency caused by intestinal malabsorption. This study investigated the efficacy and safety of parenteral vitamin D supplementation in infants and children with vitamin D deficiency caused by intestinal malabsorption.MethodsThis study included 11 patients with vitamin D deficiency who were unresponsive to oral vitamin D or were unable to try oral vitamin D therapy due to underlying conditions. All patients were treated with weekly intramuscular injection of cholecalciferol 50,000 IU. Radiological findings and biochemical parameters including serum calcium, phosphorus, alkaline phosphatase, 25-hydroxyvitamin D₃ (25(OH)D₃), and parathyroid hormone levels were reviewed retrospectively.ResultsUnderlying diseases included small bowel atresia (n=3), necrotizing enterocolitis (n=3), congenital megacolon (n=2), chronic intestinal pseudoobstruction (n=1), congenital mesenteric band (n=1), and Crohn disease (n=1). Three patients exhibited rickets on X-ray findings. The mean duration of treatment was 4.8±2.9 weeks. The alkaline phosphatase levels were decreased from 710±650 IU/L to 442±284 IU/L (P=0.143). The 25(OH)D3 level was increased from 6.0±3.4 ng/mL to 50.4±28.8 ng/mL (P=0.008) after 3 months. Two patients with rickets showed improved radiologic findings after parenteral treatment.ConclusionsParenteral vitamin D therapy was effective and safe in patients with vitamin D deficiency caused by intestinal malabsorption. Long-term follow-up is needed to establish the efficacy of parenteral vitamin D therapy in a large number of patients.

Fetal Meconium Peritonitis - Prenatal Findings and Postnatal Outcome: A Case Series, Systematic Review, and Meta-Analysis.

To describe the postnatal outcome of fetal meconium peritonitis and identify prenatal predictors of neonatal surgery. We retrospectively reviewed all fetuses with ultrasound findings suspicious for meconium peritonitis at a single center over a 10-year period. A systematic review and meta-analysis were then performed pooling our results with previous studies assessing prenatally diagnosed meconium peritonitis and postnatal outcome. Prenatal sonographic findings were analyzed to identify predictors for postnatal surgery. 34 cases suggestive of meconium peritonitis were diagnosed at our center. These were pooled with cases from 14other studies yielding a total of 244 cases. Postnatal abdominal surgery was required in two thirds of case (66.5 %). The strongest predictor of neonatal surgery was meconium pseudocyst (OR [95 % CI] 6.75 [2.53-18.01]), followed by bowel dilation (OR [95 % CI] 4.17 [1.93-9.05]) and ascites (OR [95 % CI] 2.57 [1.07-5.24]). The most common cause of intestinal perforation and meconium peritonitis, found in 52.2 % of the cases, was small bowel atresia. Cystic fibrosis was diagnosed in 9.8 % of cases. Short-term neonatal outcomes were favorable, with a post-operative mortality rate of 8.1 % and a survival rate of 100 % in neonates not requiring surgery. Meconium pseudocysts, bowel dilation, and ascites are prenatal predictors of neonatal surgery in cases of meconium peritonitis. Fetuses with these findings should be delivered in centers with pediatric surgery services. Though the prognosis is favorable, cystic fibrosis complicates postnatal outcomes.

Bowel Obstruction in the First Month of Life

Background: The aim of this study was to analyze the etiology, symptom frequency, management, and surgical outcome of gastrointestinal obstruction in the first month of life.Methods: A total of 72 neonates with gastrointestinal obstruction were reviewed over a period of 16 months.Results: The male to female ratio was 2.4:1. In this study, 75% of the neonates were presented in the first 7 days of life. The mean gestational age was 39.25 weeks. In addition, 68 of the neonates were term babies. The most common cause of admission was anorectal malformation (22%); furthermore, small bowel atresia was observed in 15% of the cases. Vomiting was the most common symptom of gastrointestinal obstruction reported in 31% of the cases, followed by abdominal distension. In this study, the overall mortality after surgery was 17%. The significant determining cause of mortality was sepsis reported in 33% of the cases.Conclusion: Early referral, diagnosis, and treatment of gastrointestinal obstruction in neonates are needed to improve the survival outcome. The most common cause of neonatal gastrointestinal obstruction was found to be imperforate anus.

Supplementation of Mother's Own Milk with Donor Milk in Infants with Gastroschisis or Intestinal Atresia: A Retrospective Study.

Background: Mother’s own milk (MOM) improves in-hospital outcomes for preterm infants. If unavailable, donor milk (DM) is often substituted. It is unclear if DM vs. formula to supplement MOM is associated with improved in-hospital outcomes in term/late preterm surgical infants with gastroschisis or intestinal atresia. Methods: This retrospective study included infants born ≥33 weeks gestational age (GA) with a birth weight of >1500 g who were admitted to a quaternary neonatal intensive care unit (NICU). Using Chi square and Mann-Whitney u testing, we compared hospital outcomes (length of stay, parenteral nutrition and central line days) before and after a clinical practice change to offer DM instead of formula in this surgical population. Results: Baseline characteristics were similar between eras for the 140 infants (median GA 37 weeks). Fewer infants in DM era were receiving formula at discharge (50.0% vs. 31.4%, p = 0.03). In sub-analyses including only small bowel atresia and gastroschisis infants, the median length of stay (35 vs. 25, p < 0.01) and the central line days (28 vs. 20, p < 0.01) were lower in the DM era. Conclusion: In this retrospective study, offering DM instead of formula was associated with less formula feeding at discharge, and in infants with gastroschisis or small bowel atresia, shorter length of stay and central line days.

Laparoscopic anastomosis of the small intestine in the presence of atresia caused by intrauterine invagination

Introduction . Intrauterine invagination is one of rare reasons that can result in small bowel atresia. The aim of the study is to demonstrate that laparoscopy can be used to treat the disease. Material and methods . The study describes an experience of endosurgical treatment of a patient with small bowel IIIA type atresia due to invagination that occurred in the prenatal period. The boy was premature; at the moment of birth his gestational age was 2 weeks and his weight was 1,280 g. Technical details of a surgical procedure along with its early and remote results were presented. Results . Intestinal atresia was operated on the 2 nd day of life. They used a soft carboperitoneum with the following carbon dioxide findings: flow of 1.5 L/min, pressure of 8 mm Hg. An optical port was installed into the left iliac region. Two other instrumental ports were located bilateral to the telescope ensuring the triangulation principle. Ileac atresia type IIIA located 8 cm away from the ileocecal valve was found during an abdominal examination. Closed ends of adducent and abducent bowels were resected. An additional formation in the form of an intrauterine intestinal invagination was found in a distal segment lumen during its resection. Completely laparoscopic intracorporeal intestinal anastomosis was performed. The surgery lasted 65 minutes. Enteral feeding was given on the 2 nd day of the surgery. Complete enteral feeding was restored on the 5 th day following the surgery. No signs of anastomotic leak were observed in the early observational period. The infant was discharged from the hospital when he was 28 days old and weighed 1,800 g. No signs of intestinal transit were found during 6 months of observation. Conclusion . Laparoscopic anastomosis performed at a children’s surgical center is an alternative to open surgery during the management of patients with small bowel atresia caused by intrauterine invagination. More extensive multicenter trials are required to determine the role of laparoscopy in treatment of this disease.

LAPAROSCOPIC ANASTOMOSIS IN THE ATRESIA OF SMALL BOWEL

Introduction. A complete laparoscopic intestinal anastomosis remains a challenge for pediatric surgeons. The aim of the study is to demonstrate its effectiveness in patients with small bowel atresia. Material and methods. This article describes laparoscopic surgery in a patient with small bowel atresia of type I. During laparoscopy, stitches were placed on the blind end of the atresia segment of the intestine to stabilize the movable intestinal segment; the stitches were passed transdermally to the outside. The design of the laparoscopic anastomosis did not differ from that of the open technique proposed by Jannie Louw. At the final stage of the trial, the researchers assessed immediate and long-term results after this new surgical intervention. Results. Laparoscopic intervention for small bowel atresia of type I was performed on the second day of life. The surgery lasted for 75 minutes. No complications were registered during it. The enteral nutrition was started after the decrease in the rate of losses in the gastric tube lower than 10 ml / kg / day. It was on day 3 after the surgery. A gradual increase in the volume of feeding promoted patient’s transfer to the full enteral nutrition on day 7 after the surgery. Next day, the baby was discharged from the hospital. Early follow-up revealed no any signs of anastomosis failure. One-year follow-up revealed no signs of impaired intestinal transit too. Conclusion. It seems that the care of small bowel atresia has taken a significant step forward. Anastomoses constructed laparoscopically in such patients are not only a possible option, they have demonstrated their effectiveness and safety as well.