Comparison of Hand-Sewn with Stapled Anastomosis in Neonatal Intestinal Atresia Surgery: A Randomized Controlled Study

Zheng, Zebing; Jin, Zhu; Gao, Mingjuan; Tang, Chengyan; Gong, Yuanyuan; Huang, Lu; Liu, Yuanmei; Wang, Jian

doi:10.1089/lap.2021.0714

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…Therefore, a crucial step is to find the means to adjust the diameter to perform a primary reconstruction. At our local institution, we do not have access to linear staplers, which have been reported to significantly shorten the operative time, improve the rapid onset of peristalsis, make early feeds possible, and reduce the time of hospital stay [ 6 , 7 ]; thus, the solution we found was to perform a hand-sewn reduction tapering of the proximal segment. This procedure has several advantages: it reduces the diameter of the proximal dilated bowel to adapt to the small and narrow distal intestinal segment, it accelerates fluids through the anastomosis, reduces stasis and, therefore, the risk of bacterial translocation, and significantly reduces septicemia [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Experience in the Management of Complex Apple Peel Intestinal Atresia in a Limited-Resource Health Center in Mexico

Rico-Tafoya,

Serrano-Meneses,

Serrano-Meneses

et al. 2024

Cureus

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Surgical treatment of complex intestinal atresia is challenging. Moreover, multiple surgical techniques have been described to treat these congenital malformations. As no single/universal technique is useful for every patient, individualized surgical treatment for these complex cases is mandatory. Isolated apple peel atresia (type IIIb), in coexistence with other types of atresia, is a rare event with a poor functional prognosis, which is difficult to treat surgically. Furthermore, the ability to achieve good surgical results becomes more difficult in resource-limited health facilities, such as the Hospital Pediatrico Moctezuma (Mexico City). The objective of this case report of two full-term female newborns with isolated apple peel atresia and an apple peel malformation with distal type IV atresia is to describe the successful surgical technique used in these patients and how to deal with certain postsurgical complications.

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Section: Discussionmentioning

confidence: 99%

Experience in the Management of Complex Apple Peel Intestinal Atresia in a Limited-Resource Health Center in Mexico

Rico-Tafoya,

Serrano-Meneses,

Serrano-Meneses

et al. 2024

Cureus

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“…The recent development of instruments with a smaller width and staplers with a smaller depth during the endoscopic surgical era allowed the application of stapled anastomosis to the pediatric population. In a previous randomized controlled study comparing hand-sewn anastomosis with stapled anastomosis in neonatal surgery, no significant differences in the anastomotic stricture, leakage, and other complications were found [ 14 ]. Moreover, when the lumen diameter was < 1.0 cm, stapled anastomosis was not applicable; otherwise, stapled anastomosis could be performed safely.…”

Section: Discussionmentioning

confidence: 99%

Tubular intestinal duplication extending from the stomach to the ileum associated with multiple intestinal atresia and situs inversus: a case report

et al. 2023

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Background Duplication of the alimentary tract can occur in any of its parts. For duodenal duplication, complete resection is particularly difficult when the ampulla of Vater is on the duplicated lumen and a deliberate management is necessary. Case presentation A 0-day female baby was referred to our department due to abdominal distention. The X-ray examination showed dextrocardia and opacity of the liver on the left side and abdominal ultrasonogram revealed remarkable intestinal dilatation. Therefore, urgent laparotomy was performed on the day of birth. Complete situs inversus of the abdominal organs was revealed, and the origin of the jejunum was on the left side and was accompanied by tubular intestinal duplication. The origin of the duplicated intestine was at the pancreatic head’s dorsal area. There were two points of type Шa atresia on the ileum. Therefore, we spared the duplicated intestine with a length of 3 cm to secure the passage of the biliary and pancreatic juices by a functional-side-to-side anastomosis with a 45-mm Endo-GIA™ camel load (Medtronic, Minneapolis, MN, USA). The ileum was transected at the distal side of the atresia point, and end-to-end jejunoileostomy was performed. Postoperative gastrointestinal series revealed remnants of the duplicated alimentary tract on the dorsal area of the stomach. Conclusions Identifying the position of the ampulla of Vater is crucial in the surgery of alimentary tract duplication with duodenal involvement. However, in the present case, it was difficult to identify whether the ampulla of Vater was on the true or duplicated lumen, and we had to spare the duplicated duodenum. Stapler anastomosis could be performed safely even in neonatal cases.

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“…With the development of anastomotic techniques and materials, anastomotic leakage and stenosis have become minimal. The reason why the number of anastomosis was excluded may be that the increased number did not increase the probability of complications ( 18 , 19 ). The short mesenteries can generate small and twisted bowels, and it also weaken the blood supply to the intestines.…”

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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Comparison of Hand-Sewn with Stapled Anastomosis in Neonatal Intestinal Atresia Surgery: A Randomized Controlled Study

Cited by 5 publications

References 15 publications

Experience in the Management of Complex Apple Peel Intestinal Atresia in a Limited-Resource Health Center in Mexico

Experience in the Management of Complex Apple Peel Intestinal Atresia in a Limited-Resource Health Center in Mexico

Tubular intestinal duplication extending from the stomach to the ileum associated with multiple intestinal atresia and situs inversus: a case report

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

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