Application of Jejunal Turnover and Bowel Plication Technique in Neonatal High Intestinal Atresia: A Retrospective Study

Abstract

Objective To evaluate the outcomes of jejunal turnover and bowel plication (JTBP) in high jejunal atresia of neonates.

Materials and Methods The clinical data of neonates that met the criteria were retrospectively analyzed from January 2012 to December 2021. The neonates were divided into the JTBP group and control group according to the surgical procedure. Demographics, postoperative morphology of the duodenum and proximal jejunum, intestinal recovery time, and complications were compared.

Results A total of 75 patients were allocated to the JTBP (n = 30) and control (n = 45) groups, respectively. There was no significant difference between the two groups in terms of gestational age, birth weight, age at surgery, the pathological classification, and concomitant disease. Upper gastrointestinal contrast study showed that the diameter of the proximal bowel of the anastomotic stoma was normal and the duodenum and proximal jejunum were in streamline shape in the JTBP group. While the duodenum was dilated, the shape of Trojan angle was classified into sharp angle and blunt round angle in the control group. The duration of total parenteral nutrition, postoperative oral feeding time, and oral feeding time of 40 mL/3 h were significantly different between the JTBP group and control group (sharp and blunt round type): 9.0 ± 3.5, 7.0 ± 2.1, and 11.0 ± 6.0 versus 16.9 ± 4.2, 14.0 ± 5.0, and 19.0 ± 7.4 versus 11.9 ± 8.3, 8.2 ± 3.9, and 15.8 ± 3.6 days (p < 0.05).

Conclusions JTBP for neonatal high jejunal atresia can significantly change the diameter of the proximal bowel and the course of duodenum jejunum flexure. Postoperative bowel movement was more in line with fluid dynamics, which was conducive to the recovery of the intestinal function and resulted in fewer complications.

Keywords

jejunal turnover - bowel plication - high jejunal atresia - neonate - case–control study

Publication History

Received: 20 April 2023

Accepted: 15 August 2023

Accepted Manuscript online:
17 August 2023

Article published online:
27 December 2024

• References

• 1 Lee SH, Cho YH, Kim HY, Park JH, Byun SY. Clinical experience of complex jejunal atresia. Pediatr Surg Int 2012; 28 (11) 1079-1083
• 2 Stollman TH, de Blaauw I, Wijnen MHWA. et al. Decreased mortality but increased morbidity in neonates with jejunoileal atresia; a study of 114 cases over a 34-year period. J Pediatr Surg 2009; 44 (01) 217-221
• 3 Yasumasa I, Koichiro A, Inhyeok C. et al. Intestinal flow after anastomotic operations in neonates. Comput Biol Med 2020; 18: 103471
• 4 Harper L, Michel JL, de Napoli-Cocci S. et al. One-step management of apple-peel atresia. Acta Chir Belg 2009; 109 (06) 775-777
• 5 Hasan Z, Gangopadhyay AN, Srivastava P, Hussain MA. Concavo-convex oblique anastomosis technique for jejuno ileal atresia. J Indian Assoc Pediatr Surg 2009; 14 (04) 207-209
• 6 Peng YF, Zheng HQ, Zhang H. et al. Comparison of outcomes following three surgical techniques for patients with severe jejunoileal atresia. Gastroenterol Rep (Oxf) 2019; 7 (06) 444-448
• 7 Dewberry LC, Hilton SA, Vuille-Dit-Bille RN, Liechty KW. Is tapering enteroplasty an alternative to resection of dilated bowel in small intestinal atresia?. J Surg Res 2020; 246: 1-5
• 8 Luo CC, Ming YC, Chao HC, Chu SM. Duodenal derotation and extent tapering jejunoplasty as primary repair for neonates with high jejunal atresia. Pediatr Neonatol 2010; 51 (05) 269-272
• 9 Nassar S, Menias CO, Palmquist S. et al. Ligament of Treitz: anatomy, relevance of radiologic findings, and radiologic-pathologic correlation. AJR Am J Roentgenol 2021; 216 (04) 927-934
• 10 Yang S, Wang M, Shen C. Bowel plication in neonatal high jejunal atresia. Medicine (Baltimore) 2019; 98 (19) e15459