Minimal access approach to jejunal atresia.
OBJECTIVE
Jejunal atresia (JA) is a common cause of intestinal obstruction in the newborn. It is corrected by small bowel tapering/excision and end-to-end enteroenterostomy, performed through a transverse laparotomy incision. It has excellent result with minimal morbidity and mortality. This incision can be reduced to a circumumbilical type as has been described for hypertrophic pyloric stenosis.


METHODS
Sixteen neonates, aged 1 to 8 days, underwent JA repair via this approach over a 3-year period.


RESULTS
The small bowel is easily accessible through this approach in all but 1 case, where a suspected colonic atresia, combined with JA, necessitated an extension to classical incision. Thirteen patients had an uneventful recovery; 2 cases required revision for anastomotic strictures, which was done through the same incision. Postoperative follow-up at 6 months showed well-healed skin incisions that were hardly visible and integrating well with the natural umbilical fold.


CONCLUSIONS
Circumumbilical incision permits an adequate approach to correction of JA. It has minimal complications and a superior cosmesis compared to the classical approach.
Banieghbal
Behrouz
B
Division of Pediatric Surgery, University of the Witwatersrand, Johannesburg, South Africa. banieghbal@worldonline.co.za
Beale
Peter G
PG
D004766:Enterostomy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000601:surgery*; D007583:Jejunum / Q000002:abnormalities*; D019060:Minimally Invasive Surgical Procedures; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*