Primary resection and anastomosis for complicated meconium ileus: a safe procedure?

Abstract

Various options are available for the surgical treatment of meconium ileus (MI). This paper examines the use of resection and primary anastomosis as the favoured option for the treatment of complicated meconium ileus. This was a retrospective study. All patients (13 children) with MI treated with primary resection and anastomosis (RA) in the 10-year period (1996-2005) at St Mary's Hospital in Manchester were identified. The case notes were retrieved. The gestational age, type of surgery, length of bowel resection and complications were recorded. Out of 13 (3 males, 10 females), 7 had severely dilated bowels, 5 had perforation and 1 had volvulus. Mean length of bowel resection was 33.8 cm (range 20-50 cm). Overall survival in this group was 85%. Seven patients (54%) developed complications. Four (31%) had surgical complications: two anastomotic strictures with adhesions, one adhesive intestinal obstruction and one intra-abdominal drain retraction. Primary resection and anastomosis is a safe option in the treatment of complicated meconium ileus. It has the advantage of less hospital stay and avoids a secondary laparotomy for closure of the stoma.

Issues in the management of simple and complex meconium ileus

“…Jawaheer et al . [26] report complications requiring additional surgery in 4 out of 13 patients (31%) after RPA, which is in line with our experience (complications in 21%). They consider RPA as a safe option for all complex MI patients apart from those with unstable condition and impaired perfusion of intestinal margins, the advantages being reduced hospital stay, avoidance of stoma-related morbidity and second laparotomy for stoma closure [26].…”

“…In case of failure, complication, or complex MI, a surgical procedure is required. Enterotomy and bowel irrigation; T-tube ileostomy; resection of atretic segments, compromised bowel, or strongly dilated bowel followed by primary anastomosis (RPA); Bishop–Koop ileostomy; Santulli procedure and Mikulicz procedure are common procedures for MI [1, 5–7, 16–26]. Although every author seems to have a preferred technique, only few comparative studies have been performed [16–26].…”

A review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon

“…They found that 21% of the primary anastomosis group developed peritonitis, whereas none of the resection with enterostomy group did. Jawaheer et al [49] found a 31% surgical complication rate in a report of MI treated with primary anastomosis. Del Pin et al [50], however, found no difference in morbidity with primary anastomosis vs resection with enterostomy.…”

Gastrointestinal and Hepatobiliary Disease in Cystic Fibrosis

“…43 Intraoperative disimpaction is achieved via irrigation through tube enterostomy, which may be done through an appendiceal stump after appendectomy, followed by resection of compromised bowel and a primary anastomosis or enterostomy. [64][65][66][67] Resection with anastomosis may increase risk for anastomotic leakage and morbidity compared with primary anastomosis, but results are inconclusive. 60,67,68 This needs to be weighed against the fluid, electrolyte, and nutrient losses from an enterostomy, which should be reversed as soon as possible.…”

“…[64][65][66][67] Resection with anastomosis may increase risk for anastomotic leakage and morbidity compared with primary anastomosis, but results are inconclusive. 60,67,68 This needs to be weighed against the fluid, electrolyte, and nutrient losses from an enterostomy, which should be reversed as soon as possible.…”