Neonatal intestinal obstruction: reducing short-term complications by surgical refinements.
Over the last ten years advances in neonatal intensive care, such as the advent of parenteral nutrition, have led to a significant decrease in the mortality rates of neonates with intestinal obstruction. Nevertheless, surgical short-term complications associated with the intestinal anastomosis performed, such as stenosis or leakage, and long-term nutritional complications due to extensive resections are still responsible for mortality and for a high morbidity rate. 39 newborns referred to our hospital in the past 3 years for intestinal obstruction were retrospectively evaluated with particular attention to the surgical management, surgical techniques and subsequent complications. Age on admission was from 1 hour to 24 days; weight from 1.4 to 3.8 kg; 41% of newborns had a prenatal diagnosis. 57 surgical procedures were performed: among them 44 intestinal anastomoses. Short-term surgical complications, namely perforation and stenosis, were observed in 18.1% of anastomoses. The complication rate after simple end-to-end anastomosis was as high as 30%. However, certain technical refinements such as tailoring the dilated upper pouch, positioning a transanastomotic feeding tube and an intubated lateral stoma resulted in a much lower complication rate (3.7%). Thus, in our experience these technical refinements are effective in reducing the incidence of short-term surgical complications.
Bagolan
P
P
Division of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Nappo
S
S
Trucchi
A
A
Ferro
F
F
Alessandri
A
A
D000714:Anastomosis, Surgical / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000295:instrumentation; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000151:congenital* / Q000401:mortality / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013528:Surgical Staplers; D015996:Survival Rate; D013536:Suture Techniques / Q000295:instrumentation; D016896:Treatment Outcome