Apple-peel intestinal atresia: Enteroplasty for intestinal lengthening and primary anastomosis

Onofre, Luciano Silveira; Maranhão, Renato Frota de Albuquerque; Martins, E. C. S.; Fachin, Camila Girardi; Martins, José Luiz

doi:10.1016/j.jpedsurg.2013.04.024

Cited by 13 publications

(7 citation statements)

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“…Intriguingly, mesangial dysplasia was ruled out in the initial screening. The possible explanation is that the determination of mesangial dysplasia depends on the subjective judgment of the surgeon, and the corresponding bowels are removed directly in severe cases, or even the treatment is given up ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

The multivariate cox regression model for complete enteral nutrition after primary anastomosis in neonates with intestinal atresia

et al. 2022

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ObjectiveEnteral feeding after intestinal atresia has always been a concern for clinicians. But the present studies mainly focused on single factors. This research aimed to comprehensively analyze the multiple factors on complete enteral nutrition after primary anastomosis, and establish the convenient prediction model.MethodsWe retrospectively collected reliable information in neonates with intestinal atresia form January 2010 to June 2022. The cox regression analysis was performed to select independent risk factors and develop nomogram. Subsequently, ROC curve, calibration curve and decision curve were drawn to thoroughly evaluate the accuracy and applicability of the model.ResultsThe predictors finally included in the model were gestational age, meconium peritonitis, distance from the anastomosis to the ileocecal region, diameter ratio of proximal to distal bowels, and time of initial feeding. The nomogram of predicting the probability of week 2, week 3 and week 4 was drawn and their area under the curve were 0.765, 0.785 and 0.747, respectively. Similarly, calibration and decision curve indicated that the prediction model had a great prediction performance.ConclusionThe clinical value of predictive models can be recognized. The hope is that the predictive model can help pediatricians reduce hospital costs and parental anxiety.

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Section: Discussionmentioning

confidence: 99%

The multivariate cox regression model for complete enteral nutrition after primary anastomosis in neonates with intestinal atresia

et al. 2022

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“…Three years later, Li et al [13] reported the management of intestinal lengthening in the first time, using LAS. They used the Onofre's technique with an anterior flap from the antimesenteric border of the dilated blind proximal segment [14]. In 2020, a retrospective cohort study compared LAS and open (extended supraumbilical transverse laparotomy) management of JIA [2].…”

Section: Discussionmentioning

confidence: 99%

Jejuno-ileal atresia: evaluation of the efficacy of laparoscopic approach

2020

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Aim Jejuno-ileal atresia is a main cause of neonatal intestinal obstructions, and minimal access technique is gaining popularity. Aim of this study was to perform systematic review of laparoscopic approach with regards its management efficacy. Methods Pubmed® was searched using terms 'jejunal', 'jejuno-intestinal atresia', 'laparoscopic' or 'laparoscopic-assisted'. Data collected included gender, age, weight, comorbidities, surgical technique, duration of surgery, complications, reoperation, mortality, parenteral feeding time. Results 5 articles (2004-2020) met the inclusion criteria with 63 neonates. Mean weight was 2.6 kg. There were n = 16 comorbidities: cardiac anomalies (n = 5), Meckel's diverticulum (n = 2), meconium peritonitis (n = 4), unknown (n = 5). All patients had laparoscopic-assisted surgery, out of which n = 25 were single-port approach. Conversion was reported in n = 4 cases due to meconium ileus (n = 2), or significantly dilated bowel (n = 2). There were n = 7 complications (n = 1 sepsis, n = 2 anastomotic leaks, n = 1 cholestasis, n = 3 adhesive ileus). Two reoperations were necessary because of anastomotic dehiscence (n = 1) and adhesive ileus (n = 1). Mean parenteral feeding time was 13 days. There were three lethal outcomes, due to sepsis after anastomotic leak (n = 1), severe cardiac defect (n = 1), pneumonia and adhesive ileus (n = 1). Conclusions Laparoscopic-assisted is opted for jejuno-ileal atresia when minimal access approach is preferred. It is fast and feasible technique, which offers better cosmesis, may result shorter length of operation and recovery. There is > 10% complication rate, which rarely require reoperation. Limitation of this approach are low weight babies with associated anomalies, or significantly dilated proximal bowels. These remain the main concern for laparoscopic-assisted surgery, which require open approach or conversion.

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“…Although there is no clear difference in mortality among the classes of jejunoileal atresia, type IIIB and IV are more commonly associated with SBS, which can occur in up to 1/3 of these cases [8,21]. The lack of bowel length in type IIIB atresia sometimes necessitates creative bowel-preserving procedures in order to minimize the risk of developing SBS [22]. In this unusual case of apple-peel atresia, the abundance of bowel length negated the need for such strategies.…”

Section: Discussionmentioning

confidence: 99%

A new variant of type III jejunoileal atresia

Dao

Demehri

Buchmiller

2019

Journal of Pediatric Surgery

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Jejunoileal atresia (JIA) is a congenital defect that can result in significant loss of bowel length. The traditional classification of JIA was first proposed by Grosfeld and includes 4 subtypes. Among these, type IIIB, or apple-peel atresia, is characterized by a proximal atretic jejunum and a distal segment of spiraled bowel that terminates at the cecum. Due to this anatomy, patients with type IIIB JIA are at increased risk for short bowel syndrome and intestinal failure. In this report, we described the case of a neonate with a prenatal diagnosis of JIA. At exploration, she was initially found to have a type IIIB atresia. However, instead of terminating at the cecum, the distal spiraled segment was followed by 75 cm of normal small bowel and mesentery. Surgical correction proceeded with minimal resection and primary anastomosis. She recovered well from this procedure, tolerated full enteral nutrition by mouth, and displayed good weight gain at outpatient follow-up. Due to the unique anatomy of the gastrointestinal tract in this case report, we propose the addition of a new class of JIA, type IIIC, to better reflect its prognostication and surgical management.

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Apple-peel intestinal atresia: Enteroplasty for intestinal lengthening and primary anastomosis

Cited by 13 publications

References 10 publications

The multivariate cox regression model for complete enteral nutrition after primary anastomosis in neonates with intestinal atresia

The multivariate cox regression model for complete enteral nutrition after primary anastomosis in neonates with intestinal atresia

Jejuno-ileal atresia: evaluation of the efficacy of laparoscopic approach

A new variant of type III jejunoileal atresia

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