Staged surgical treatment of apple peel intestinal atresia

Jalles, Filipa; Morgado, Mariana; Janeiro, Marta; Gonçalves, Marcela Letícia Leal

doi:10.1016/j.epsc.2019.101293

Cited by 1 publication

(1 citation statement)

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“…Since this complex subtype of atresia was initially described, several authors have reported their experiences in the management of apple-peel atresia. Roughly, most of these cases were managed by primary end-to-end linear anastomosis ( 4 ), while others resort to double enterostomies, or partial anastomoses, whether end-to-side or side-to-end ( 5 – 7 ). Marked improvement in survival was partially attributable to enhanced surgical technique, and mainly due to improved perioperative management and especially total parenteral nutrition (TPN).…”

Section: Introductionmentioning

confidence: 99%

T-tube enterostomy in the management of apple-peel atresia: A case series from a single center

Rashwan

Kotb

2022

Front. Pediatr.

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Background and objectiveAlthough complex atresias, such as apple-peel and multiple atresias, comprise a smaller percentage, they are usually associated with a higher incidence of postoperative complications and mortality rate. Contrary to simple atresias where the surgical technique of choice usually entails bowel resection and anastomosis with or without enteroplasty, managing apple-peel atresia remains more sophisticated. Decompressive and functionalizing stomas are sometimes mandatory to overcome problems such as increased wall thickness and the wide disparity among the anastomotic ends. Few reports discussed using tube enterostomy in the management of apple-peel atresia; nonetheless, no previous prospective studies were conducted to discuss its efficacy on a larger population. In this study, we are describing our experience using this technique on 12 patients suffering from apple-peel atresia in our center.MethodsA prospective study was conducted from June 2015 to May 2020, where all children who were found to have apple-peel atresia were included in the study. T-tube was placed through an enterotomy through the dilated proximal bowel, around 10 cm before the anastomotic line, and was kept in place using a double suture (Stamm technique) before closing the anterior face of the anastomosis. The short distal limb of the T-tube was oriented toward the anastomotic line, while the long proximal limb was directed proximally. After finishing the anastomosis, the T-tube was delivered outside the abdominal wall, anchoring the enterostomy along with the proximal dilated jejunum against the anterior abdominal wall.ResultsA total of 12 cases were encountered throughout the period of study. The mean age at operation was 4 days and the mean birth weight was 2700 g. The mean time for starting oral feeding postoperatively and T-tube removal was 8 and 10.5 days, respectively. Cases were discharged after a mean of 22 days. As regards morbidity and mortality, a single case developed skin excoriations at the site of tube insertion and was managed conservatively using topical ointments and another case died from overwhelming sepsis 3 days after the operation.ConclusionT-tube enteroplasty is a safe and feasible option in the surgical management of apple-peel atresia. The main strength of our study is its prospective nature and that it includes apple-peel atresia cases only. However, the main limitation is that a larger sample is needed.

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Section: Introductionmentioning

confidence: 99%