title: Supra-transumbilical laparotomy (STL) approach for small bowel atresia repair: our experience and review of the literature.
abstract: BACKGROUND
  Supra-Transumbilical Laparotomy (STL) has been used in paediatric surgery for a broad spectrum of abdominal procedures. We report our experience with STL approach for small bowel atresia repair in newborns and review previous published series on the topic.
  
  
  METHODS
  Fourteen patients with small bowel atresia were treated via STL approach at our Institution over a 5-year period and their charts were retrospectively reviewed.
  
  
  RESULTS
  STL procedure was performed at mean age of 3.1 day. No malrotation disorders were detected with pre-operative contrast enema. Eight patients (54.1%) presented jejunal atresia, five (35.7%) ileal atresia, and one (7.1%) multiple ileal and jejunal atresias. Standard repair with primary end-to-back anastomosis was performed in all but one patient. In the newborn with multiple atresia, STL incision was converted in supra-umbilical transverse incision due to difficulty of exposition. After surgery, one patient developed anastomotic stricture, and another developed occlusion due to adhesions: Both infants required second laparotomy. No infections of the umbilical site were recorded, and cosmetic results were excellent in all patients.
  
  
  CONCLUSIONS
  Increasing evidence suggests that STL approach for small bowel atresia is feasible, safe and provides adequate exposure for small bowel atresia surgery. When malrotation and colonic/multiple atresia are pre-operatively ruled out, STL procedure can be chosen as first approach.
authors.affiliation: Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Leva
authors.forename: Filippo
authors.initials: F
authors.lastname: Parolini
authors.forename: Andrea
authors.initials: A
authors.lastname: Zanini
authors.forename: Anna
authors.initials: A
authors.lastname: Morandi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Farris
authors.forename: Stefania
authors.initials: S
authors.lastname: Franzini
authors.forename: Maurzio
authors.initials: M
authors.lastname: Torricelli
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000601:surgery*; D007421:Intestine, Small / Q000002:abnormalities* / Q000601:surgery; D007813:Laparotomy / Q000379:methods*; D014472:Umbilicus / Q000601:surgery