Jejuno-ileal atresia: evaluation of the efficacy of laparoscopic approach
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ORIGINAL RESEARCH
Jejuno‑ileal atresia: evaluation of the efficacy of laparoscopic approach Anna Rieth1 · Brigitta Balogh1 · Tamás Kovács1 Received: 4 July 2020 / Revised: 16 August 2020 / Accepted: 23 August 2020 © Springer Nature Singapore Pte Ltd 2020
Abstract 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. Keywords Jejuno-ileal atresia · Jejunal atresia · Laparoscopic-assisted · Laparoscopic
Background 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 [1–4]. The prevalence of JIA is approximately 1:330–1:1500 live births, however every third of them are either premature
* Anna Rieth [email protected]‑szeged.hu 1
Divison of Pediatric Surgery, Department of Pediatrics, University of Szeged, Korányi avenue 14‑15, 6725 Szeged, Hungary
or small for gestational age [2]. Prenatal diagnosis is successful in 29–50% by ultrasound examination [1]. The classic operative technique is a tr
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