title: The extramucosal interrupted end-to-end intestinal anastomosis in infants and children; a single surgeon 21year experience.
abstract: OBJECTIVE
  To report outcomes of a standardised technique for intestinal anastomosis in infants and children.
  
  
  METHODS
  Data were prospectively collected on all paediatric intestinal anastomosis by a single surgeon over a 21year period. Anastomoses were constructed using an end-to-end extramucosal technique with interrupted polypropylene sutures. Demographic and clinical data were recorded.
  
  
  RESULTS
  Six-hundred and thirteen anastomoses were constructed in 550 patients. Median age at time of anastomosis was 6months (range 1day-226months). The most common reason for anastomosis was stoma closure (n=271, 49%). For those patients that required multiple anastomoses the most common pathology was acute NEC (n=22/41, 54%). One-hundred and one (18.4%) patients passed stool within 24hours of surgery, 175 (31.8%) between 24-48 hours and 95 (17.3%) between 48-72 hours. Anastomotic complications occurred in 7 patients (1.3%) including anastomotic leakage (n=5, 0.9%) and anastomotic stricture (n=2, 0.4%). The majority of anastomotic leakages (80%) followed resection of acute NEC.
  
  
  CONCLUSIONS
  The interrupted extramucosal anastomosis is safe and effective. The return of bowel function is rapid and the complication rate acceptable. We recommend this technique be used for all intestinal anastomoses in children and infants.
authors.affiliation: Great Ormond Street Hospital, London UK.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Ross
authors.affiliation: Great Ormond Street Hospital, London UK.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Hall
authors.affiliation: Great Ormond Street Hospital, London UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Ahmed
authors.affiliation: Great Ormond Street Hospital, London UK. Electronic address: edwardkiely@mac.com.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Kiely
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000601:surgery*; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013536:Suture Techniques
keywords: Anastomosis; Inflammatory bowel disease; Necrotising enterocolitis; Paediatric surgery; Technique