Laparoscopy-Assisted Versus Open Surgery in Treating Intestinal Atresia: Single Center Experience

Lima, Mario; Salvo, Neil Di; Cordola, Chiara; D’Antonio, Simone; Libri, Michele; Maffi, Michela; Gargano, Tommaso; Ruggeri, Giovanni; Catania, Vincenzo Davide

doi:10.1080/08941939.2019.1704316

Cited by 12 publications

(32 citation statements)

References 32 publications

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“…The five studies (published between 2004 and 2020) involved 63 neonates [2,7,[11][12][13] (Table 1). There are four case reports [7,[11][12][13], and one with a retrospective study comparing open versus laparoscopic-assisted surgery among own patients [2]. All of them had enough detailed information to be involved in our study.…”

Section: Resultsmentioning

confidence: 99%

“…Jejuno-ileal atresia (JIA) is a well-recognized and relatively common neonatal intestinal anomaly, which is a major cause of intestinal obstruction [1]. The management of JIA has improved in recent decades, due to early diagnosis, developing neonatal intensive care service, nutritional support, and the appearance of minimal invasive operative technique [1][2][3][4]. The prevalence of JIA is approximately 1:330-1:1500 live births, however every third of them are either premature or small for gestational age [2].…”

Section: Introductionmentioning

confidence: 99%

“…Later Soutter and Askew improved Bianchi's method in the management of many neonatal abdominal anomalies, including small bowel atresia or malrotation [6]. Soutter's technique needs a 350º incision around the umbilicus, leaving only a small percutaneous bridge, but having an extended view [2,6]. Soutter had no umbilical ischemia among his patients.…”

Section: Introductionmentioning

confidence: 99%

“…Totally laparoscopic repair in case of JIA still has not been published to date, due to the difficulty of intracorporal suturing and small abdominal working space. Nevertheless, totally laparoscopic management has been already described for duodenal atresia and it has improved in recent years, but is still not widely practiced, and has many controversies [2,8]. Nowadays, there are two main concepts for minimal invasive technique of JIA: circumumbilical incision and laparoscopic-assisted surgery (LAS) [2].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, totally laparoscopic management has been already described for duodenal atresia and it has improved in recent years, but is still not widely practiced, and has many controversies [2,8]. Nowadays, there are two main concepts for minimal invasive technique of JIA: circumumbilical incision and laparoscopic-assisted surgery (LAS) [2]. We still have little experience and data about LAS in the management of jejuno-ileal atresia.…”

Section: Introductionmentioning

confidence: 99%

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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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