Journal of Shanghai Jiao Tong University (Medical Science) >

2021 , Vol. 41 >Issue 9: 1162 - 1168

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.09.005

Neonatal surgery topics

Laparoscopic diagnosis and treatment of high jejunal atresia and stenosis in neonates

  • Bao-hong ZHAO ,
  • Hong-xia REN ,
  • Xiao-xia WU ,
  • Yuan-yuan JIN ,
  • Wen-yue LIU ,
  • Liang ZHAO ,
  • Hui ZHANG ,
  • Xin GUO ,
  • Xue SUN
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  • Department of Neonatal Surgery, Children′s Hospital of Shanxi Province, Taiyuan 030025, China
REN Hong-xia, E-mail: renhongxia100@sina.com.

Received date: 2021-03-08

  Online published: 2021-08-24

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Abstract

Objective

·To investigate the effect of laparoscope on the treatment of high jejunal atresia and stenosis in neonates.

Methods

·From January 2009 to December 2019, 90 neonates with high jejunal atresia and stenosis were operated on Children′s Hospital of Shanxi province. According to whether laparoscopic surgery was used or not, they were divided into laparoscopic group (n=66) and laparotomy group (n=24). In the laparoscopic group, 27 cases of type Ⅰ atresia and stenosis less than 10 cm from Treitz ligament were anastomosed under laparoscopy, and 39 cases of jejunal atresia and stenosis 10?30 cm from the Treitz ligament, underwent extraperitoneal anastomosis by expanded trocar hole with the aid of single-site laparoscope. Traditional laparotomy exploratory incision was used in the laparotomy group. The operation time, the first postoperative oral feeding time, postoperative full oral feeding time [postoperative oral feeding volume reaching 150 mL/(kg·d)], the length of hospital stay, and mortality and incidence of complications were compared between the two groups.

Results

·There was no significant difference between the laparoscopic group and laparotomy group in age, gender, weight, premature infant, low birth weight, other systems malformation and pathological type. There was no significant difference in operation time between the laparoscopic group and laparotomy group [(77.0±24.0) min vs (82.0±24.0) min]. The first postoperative oral feeding time, postoperative full oral feeding time [postoperative oral feeding volume reaching 150 mL/(kg·d)], and the length of hospital stay in the laparoscopic group were shorter than those in the laparotomy group [(13.3±7.2) d, (19.1±8.1) d, (22.1±8.5) d vs (17.2±7.8) d,(23.7±10.6) d, (27.0±11.8) d, all P <0.05]. There was no significant difference between the laparoscopic group and laparotomy group in mortality (1/66 vs 2/24) and incidence of complications (7/66 vs 6/24).

Conclusion

·Laparoscopic surgery is a safe and effective method in the diagnosis and treatment of neonatal high jejunal atresia/stenosis.

Key words： laparoscope; jejunal atresia; neonate

Cite this article

Bao-hong ZHAO , Hong-xia REN , Xiao-xia WU , Yuan-yuan JIN , Wen-yue LIU , Liang ZHAO , Hui ZHANG , Xin GUO , Xue SUN . Laparoscopic diagnosis and treatment of high jejunal atresia and stenosis in neonates[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2021 , 41(9) : 1162 -1168 . DOI: 10.3969/j.issn.1674-8115.2021.09.005

References

1 Yeung F, Tam YH, Wong YS, et al. Early reoperations after primary repair of jejunoileal atresia in newborns[J]. J Neonatal Surg, 2016, 5(4): 42.
2 Chan KW, Lee KH, Wong HY, et al. Cystic meconium peritonitis with jejunoileal atresia: is it associated with unfavorable outcome?[J]. World J Clin Pediatr, 2017, 6(1): 40-44.
3 杨少波, 王敏, 沈淳.肠折叠术在新生儿高位空肠闭锁手术中的应用初探[J].中华小儿外科杂志, 2018, 39(12): 905-908.
4 李炳, 陈卫兵, 王寿青,等. 腹腔镜在小儿先天性小肠闭锁和狭窄诊治中的应用[J]. 中华胃肠外科杂志, 2014(8): 816-819.
5 Salimi A, Nia SR, Eftekhari SS, et al. Type Ⅰ jejunal atresia in identical twins: a rare occurrence[J]. J Neonatal Surg, 2017, 6(3): 68.
6 Grosfeld JL, Ballantine TV, Shoemaker R. Operative mangement of intestinal atresia and stenosis based on pathologic findings[J]. J Pediatr Surg, 1979, 14(3): 368-375.
7 Stollman TH, de Blaauw I, Wijnen MH, et al. Decreased mortality but increased morbidity in neonates with jejunoileal atresia; a study of 114 cases over a 34-year period[J]. J Pediatr Surg, 2009, 44(1): 217-221.
8 张红, 钟微, 孙静, 等. Bishop-Koop肠吻合肠造口术在难治型先天性小肠闭锁中的应用[J]. 中华胃肠外科杂志, 2016, 19(10): 1154-1159.
9 郭卫红, 陈永卫, 侯大为, 等. 先天性肠闭锁病死率40年回顾性分析[J]. 中华小儿外科杂志, 2011, 32(6): 434-437.
10 Rattan KN, Garg DK. Modified gut anastomotic technique in type Ⅲ and type Ⅳ jejunoileal atresias[J]. J Neonatal Surg, 2016, 5(4): 48.
11 Abhyankar A, Mukhtar Z. Laparoscopy-assisted surgery for neonatal intestinal atresia: single-center experience*[J]. Asian J Endosc Surg, 2011, 4(2): 90-93.
12 Tajiri T, Ieiri S, Kinoshita Y, et al. Transumbilical approach for neonatal surgical diseases: woundless operation[J]. Pediatr Surg Int, 2008, 24(10): 1123-1126.
13 胡博, 李戈, 戴春娟, 等. 新生儿及小婴儿腹腔镜手术适宜气腹压力的函数推导[J]. 中华小儿外科杂志, 2012, 33(5): 348-351.
14 Kumaran N, Shankar KR, Lloyd DA, et al. Trends in the management and outcome of jejuno-ileal atresia[J]. Eur J Pediatr Surg, 2002, 12(3): 163-167.
15 吴晓霞, 任红霞, 詹江华, 等.新生儿空肠闭锁术后发生坏死性小肠结肠炎的危险因素分析[J].中华小儿外科杂志, 2020, 41(12): 1090-1094.
16 Khan N, Bakht S, Zaheer N. A minor innovation in constructing a small bowel stoma in neonates with small bowel atresia to reduce the morbidity[J]. J Neonatal Surg, 2016, 5(4): 45.
17 陈焕, 耿其明, 路长贵, 等. 肠折叠术联合早期肠内营养在空肠闭锁患儿加速康复外科中的应用[J]. 中华胃肠外科杂志, 2017, 20(5): 535-539.
18 陈淑芸, 任红霞, 陈兰萍, 等. 新生儿空肠闭锁置入鼻空肠营养管术后并发肠穿孔一例[J]. 中华胃肠外科杂志, 2014(10): 1045.
19 Kato T, Hebiguchi T, Yoshino H, et al. Wing-shaped end-to-end anastomosis for the treatment of high jejunal atresia[J]. Tohoku J Exp Med, 2000, 192(2): 119-126.
20 Yamataka A, Koga H, Shimotakahara A, et al. Novel procedures for enhancing high jejunal atresia repair: bilateral side-plication and plication before anastomosis[J]. Pediatr Surg Int, 2005, 21(11): 907-910.
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