title: Preserving bowel length with a transluminal stent in neonates with multiple intestinal anastomoses: a case series and review of the literature.
abstract: OBJECTIVE
  In neonatal surgery, preserving small bowel length is important to avoid short bowel syndrome. Our aim was to assess the outcomes of intraluminal stenting of neonatal multiple intestinal anastomoses.
  
  
  METHODS
  We conducted a retrospective review of 9 patients (5, single institution; 4, published literature) who received multiple anastomoses stented by a silicon tube. Demographics, surgical anatomy and complications, nutritional outcomes, and follow-up were reviewed.
  
  
  RESULTS
  Diagnosis was multiple intestinal atresias in 8 patients and necrotizing enterocolitis in 1. A silicon catheter entered either the mucous fistula (5 patients received a jejunostomy/mucous fistula) or a proximal opening on the dilated bowel and was threaded through viable segments of the bowel. The bowel ends were approximated. Stent was externalized in 7 patients. Final mean small bowel length was 63.9 cm. All complications (3 patients, leak/stricture) required surgery. Mean time to stent removal, feeds initiation, and parenteral nutrition (PN) discontinuation was 31.2 days, 17.3 days, and 159 days, respectively. Only 1 patient remains on PN (mean follow-up, 25.4 months).
  
  
  CONCLUSIONS
  Multiple intestinal anastomoses stenting is an excellent technique to avoid short bowel syndrome in the setting of multiple viable segments of gut, such as type IV intestinal atresia or necrotizing enterocolitis. Both our experience and the published literature show no mortality and PN-free survival.
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Rodrigo L P
authors.initials: RL
authors.lastname: Romão
authors.forename: Doruk
authors.initials: D
authors.lastname: Ozgediz
authors.forename: Nicole
authors.initials: N
authors.lastname: de Silva
authors.forename: Priscilla
authors.initials: P
authors.lastname: Chiu
authors.forename: Jacob
authors.initials: J
authors.lastname: Langer
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wales
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery; D000714:Anastomosis, Surgical / Q000295:instrumentation; D057868:Anastomotic Leak / Q000601:surgery; D003251:Constriction, Pathologic / Q000601:surgery; D020345:Enterocolitis, Necrotizing / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000601:surgery; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007409:Intestinal Atresia / Q000601:surgery*; D007422:Intestines / Q000601:surgery*; D007582:Jejunostomy; D008297:Male; D010288:Parenteral Nutrition; D012086:Reoperation; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000517:prevention & control*; D015607:Stents; D013536:Suture Techniques; D016896:Treatment Outcome