Early outcomes of tapering jejunoplasty by antimesenteric seromuscular stripping and mucosal inversion for proximal jejunal atresia

Abstract

Background: High jejunal atresia is associated with significant dilatation of the proximal segment. This poses two problems: (a) calibre discrepancy with the distal unused segment and (b) hypomotility causing stasis. Tapering jejunoplasty/enteroplasty could offer a practical solution in selected cases, leading to early establishment of feeds. This work aims to evaluate the outcome of tapering jejunoplasty including its effect on establishing enteral feeding in neonates with proximal jejunal atresia. Results: Twenty-two neonates with jejunal atresia (types I, II and IIIa) were reviewed. Cases with multiple atresia, apple-peel variant and meconium ileus were excluded. The included cases fell retrospectively into two groups: group A (13 cases)-very proximal atresia and significant dilatation and group B (9 cases)-mid/distal jejunal atresia. For group A, we excised only the distal tip of the dilated bowel and stripped a seromuscular triangle up to the duodenojejunal flexure and inverted the mucosa along the antimesenteric border, followed by an end-to-oblique anastomosis. For group B, we performed a standard excision of a short proximal segment and an end-to-oblique anastomosis. There was no significant difference in the gestation age or birth weight between both groups. The mean operative time was 90 min for group A and 60 min for group B. The duration until full enteral feeds became tolerated, and parenteral nutrition was weaned accordingly was shorter in group A (mean 10.8 days) as compared to group B (mean 14.5 days), p = 0.045. Conclusion: Tapering jejunoplasty by seromuscular stripping and mucosal inversion facilitates early establishment of feeds in proximal jejunal atresia.

The incidence of different forms of ileus following surgery for abdominal birth defects in infants: a systematic review with a meta-analysis method

“…In total, 22 studies reported on paralytic ileus and entailed 1,332 patients and 120 events of paralytic ileus [ 35 , 42 , 46 , 48 , 49 , 51 , 61 , 65 , 81 , 82 , 96 , 98 , 100 , 103 , 109 , 112 , 114 , 115 , 132 , 151 , 153 , 155 ]. The pooled proportion of total paralytic ileus was 0.07 (95%-CI: 0.05–0.11; I 2 =71%, p≤0.01).…”

“…Of the 14 studies reporting on anastomotic stenosis within one month of follow-up, 365 patients were included and 22 events of anastomotic stenosis occurred [ 13 , 18 , 20 , 35 , 57 , 59 , 64 , 75 , 78 , 108 , 109 , 118 , 129 , 151 ].…”