40 years' review of intestinal atresia.
OBJECTIVE
To analyze the 40 years' experience of intestinal atresia and to introduce a new design of long-oblique anastomosis for disproportional loops of the intestine.


METHODS
A total of 449 cases of congenital atresia of the small intestine were classified into three groups according to the embryopathology: high group (145 cases), including duodenal and high jejunal atresia; middle group (288), including ileo-jejunal atresia; and low group (16), including terminal ileal atresia. To analyze the survival rate and mode of treatment, we assigned the cases into 3 groups according to the year of admission: 1) 1956-1969 (173 cases), under the general pediatric surgical care; 2) 1970-1985 (147), under the specialty neonatal surgical care; and 3) 1986-1996 (129), with additional use of total parenteral nutrition.


RESULTS
The ileojejunal atresia group (middle group) had the highest mortality rate (47.6%). The overall mortality rate decreased as the time went by, dropping from 64.7% in the early years down to 18.6% in the recent years, and no hospital death occurred in the recent couple of years.


CONCLUSIONS
Besides the improvement of neonatal surgical techniques, selecting a proper surgical procedure according to the embryopathology is essential to the reduction of mortality. The long-oblique anastomosis is particularly acceptable in China at present for marked disproportional loops.
Hou
D
D
Department of Pediatric Surgery, Beijing Children's Hospital, Capital University of Medical Sciences, Beijing 100045, China. ybbgs@public.bta.net.cn
Zhang
J
J
D000714:Anastomosis, Surgical / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods; D006801:Humans; D007409:Intestinal Atresia / Q000145:classification / Q000401:mortality / Q000601:surgery*