Intestinal atresias: factors affecting clinical outcomes

Piper, Hannah G.; Alesbury, Julia M.; Waterford, Stephen D.; Zurakowski, David; Jaksic, Tom

doi:10.1016/j.jpedsurg.2007.09.053

Cited by 78 publications

(74 citation statements)

References 6 publications

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“…5 The median LOS for duodenal atresia was 19 days (interquartile range [IQR]: 12-46 days) while for jejunal/ileal atresia, it was 25 days (IQR: 14-60 days) and for colonic atresia, it was 12 days (IQR: 8-90 days). Data in our study where intestinal atresias (n=42) were analysed together showed similar findings, with a median LOS of 24 days (range: 6-168 days).…”

Section: Intestinal Atresiamentioning

confidence: 99%

Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England

Shetty

Kennea

Desai

et al. 2016

annals

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INTRODUCTION There is a lack of knowledge on the average length of stay (LOS) in neonatal units after surgical repair of common congenital anomalies. There are few if any publications reporting the activity performed by units undertaking neonatal surgery. Such activity is important for contracting arrangements, commissioning specialist services and counselling parents. The aim of this study was to describe postnatal LOS for infants admitted to a single tertiary referral neonatal unit with congenital malformations requiring surgery. METHODS Data on nine conditions were collected prospectively for babies on the neonatal unit over a five-year period (2006)(2007)(2008)(2009)(2010)(2011). For those transferred back to their local unit following surgery, the local unit was contacted to determine the total LOS. Only those babies who had surgery during their first admission to our unit and who survived to discharge were included in the study. Cost estimates were based on the tariffs agreed for neonatal care between our trust and the London specialised commissioning group in 2011-2012. RESULTS The median LOS for the conditions studied was: gastroschisis 35 days (range: 19-154 days), oesophageal atresia 33 days (range: 9-133 days), congenital diaphragmatic hernia 28 days (range: 7-99 days), intestinal atresia 24 days (range: 6-168 days), Hirschsprung's disease 21 days (range: 15-36 days), sacrococcygeal teratoma 17 days (range: 12-55 days), myelomeningocoele 15.5 days (range: 8-24 days), anorectal malformation 15 days (range: 6-90 days) and exomphalos 12 days (range: 3-228 days). The total neonatal bed day costs for the median LOS ranged from £8,701 (myelomeningocoele) to £23,874 (gastroschisis). The cost of surgery was not included. CONCLUSIONS There is wide variation in LOS for the same conditions in a single neonatal unit. This can be explained by different types and severity within the same congenital anomalies, different surgeons and other clinical confounders (eg sepsis, surgical complications, associated anomalies). These data will enable us to give more detailed information to families following prenatal or postnatal diagnosis. They also allow more detailed planning of resource allocation for neonatal admissions.

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Section: Intestinal Atresiamentioning

confidence: 99%

Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England

Shetty

Kennea

Desai

et al. 2016

annals

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“…Small intestinal motor activity has been found to be present at 16 weeks of gestation, but coordinated contraction and peristalsis is not established until 36 weeks [14][15][16]. Prematurity and LBW had also been previously shown to be significant predictors of increased mortality of JIA by Walker et al, with term infants having a 98% survival rate compared with 87% for preterm infants [1,9].…”

Section: Discussionmentioning

confidence: 99%

“…The risk of reoperation is substantial and our finding appears to be in agreement with the impression in the existing literature although this issue has not been widely investigated. A previous study reported that 15 of 60 patients (25%) with JIA required a second abdominal operation for complications [9]. Another study recruiting 83 patients reported that 14.5% required repeat laparotomy for adhesive intestinal obstruction and another 6% for anastomotic leakage or stricture [6].…”

Section: Discussionmentioning

confidence: 99%

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Early Reoperations after Primary Repair of Jejunoileal Atresia in Newborns

et al. 2016

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Aim: To review nine-year experience in managing jejuno-ileal atresia (JIA) by primary resection and anastomosis and identify factors associated with reoperations.Methods: From April 2006 to May 2015, all consecutive neonates who underwent bowel resection and primary anastomosis for JIA were analyzed retrospectively. Patients with temporary enterostomy were excluded. Patient demographics, types of atresia, surgical techniques, need for reoperations, and long-term outcomes were investigated.Results: A total of forty-three neonates were included, in which nineteen (44.2%) of them were preterm and fourteen (32.6%) were of low birth weight. Thirteen patients (30.2%) had jejunal atresia whereas thirty patients (69.8%) had ileal atresia. Volvulus, intussusception and meconium peritonitis were noted in 12, 8, and13 patients, respectively. Eight patients (18.6%) had short bowel syndrome after operation. Ten patients (23.3%) required reoperations from 18 days to 4 months after the initial surgery due to anastomotic stricture (n=1), adhesive intestinal obstruction (n=1), small bowel perforation (n=2) and functional obstruction (n=6). Prematurity and low birth weight were associated with functional obstruction leading to reoperation (p=0.04& 0.01 respectively). The overall long-term survival was 97.7%. All surviving patients achieved enteral autonomy and catch-up growth at a median follow-up of 4.7 years.Conclusion: Long-term survival of JIA after primary resection and anastomosis are excellent. However, patients have substantial risk of early reoperations to tackle intraabdominal complications.

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“…[1][2][3] This procedure has various complications like bleeding, prolapse, ulceration, stenosis adhesions and obstruction. 4 Small bowel motility complaints leading to elevated intraluminal pressure are the well-known factors for their progress.…”

Section: Introductionmentioning

confidence: 99%

Early Recovery after Small Bowel Surgery

Ahmed¹

2017

MOJS

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Background: Bowel anastomoses are common procedures in both elective and emergency general surgery Therefore, the aim of this study was to assess the safety, tolerability and outcome of early oral feeding after small bowel anastomosis.Methodology: This is a Quasi experimental study conducted at Surgical unit (ward 26) Jinnah postgraduate medical center, Karachi, Pakistan, during the period from March 2014 to November 2016. In the present study we investigated 59 cases, their ages ranging from 17-45years.Results: Out of 35 elective cases, 51.4% were operated for ileoleal and 20% were operated for ileocolic anastomosis. Out of the 24 emergency cases, 75%, 20.8%, and 4.2% were presenting with, Penetrating abdominal trauma, Blunt trauma, and Intestinal obstruction section to internal hernia. Conclusion:Early oral feeding is safe and if associated with careful selection and multimodal postoperative care promotes faster convalescence following small bowel surgery.

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Intestinal atresias: factors affecting clinical outcomes

Cited by 78 publications

References 6 publications

Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England

Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England

Early Reoperations after Primary Repair of Jejunoileal Atresia in Newborns

Early Recovery after Small Bowel Surgery

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