One-step management of apple-peel atresia.
OBJECTIVE
Apple-peel atresia is a rare form of bowel atresia associating proximal jejunal atresia with a typical coil-shaped distal small bowel. Many of the children suffering from this condition are still managed with initial enterostomy followed by delayed anastomosis.


METHODS
Between 2000 and 2007, we managed four patients with apple-peel atresia. Three by primary anastomosis and one by initial enterostomy with delayed anastomosis.


RESULTS
Total duration of total parenteral nutrition (TPN) was an average 109 days. Survival rate was 100% with an average follow-up of 4.3 years.


CONCLUSIONS
Nowadays, the prognosis of apple-peel atresia depends mainly on prolonged TPN-related morbidity rather than immediate postoperative complications. We therefore recommend that those infants affected be managed by primary anastomosis in order to reduce the duration of parenteral nutrition, followed by careful nutrition by teams experienced in neonatal TPN and short bowel syndrome.
Harper
L
L
Department of Paediatric surgery, Félix Guyon Hospital, Centre Hospitalier Regional de La Réunion, Bellepierre, Reunion Island. harper_luke@hotmail.com
Michel
J-L
JL
de Napoli-Cocci
S
S
Aulagne
M-B
MB
Maurel
A
A
Mazouzi
S
S
Ramful
D
D
D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000601:surgery*; D008297:Male; D010289:Parenteral Nutrition, Total; D012189:Retrospective Studies