Neonatal Serial Transverse Enteroplasty (STEP): Case Report.
METHODS
Gastroschisis is the most frequent congenital abdominal wall defect. When associated with intestinal atresia (complex gastroschisis), short bowel syndrome may occur. Complicated gastroschisis is the most frequent cause of short bowel syndrome in our series. The serial transverse enteroplasty procedure has been used to lengthen the bowel and achieve intestinal rehabilitation in patients with dilated gut. The use of this technique in the newborn period, for tailoring the bowel while preserving absorptive mucosa, has been recently described. We present a video showing the surgical treatment of an intestinal obstruction produced by a complex intestinal atresia in a newborn baby in whom a primary closure of a gastroschisis had been done at birth. During laparotomy at the 21st day of life, a type IVa intestinal atresia was found, associated with a colonic stenosis. Proximal dilated jejunum was tailored with a serial transverse enteroplasty procedure, as shown in the video. End-to-end jejunal-ileal anastomosis was performed. Postoperative entero-cutaneous fistula occurred and was treated with vacuum-assisted therapy. Enteral feedings were initiated at 15 days after surgery. Parenteral nutrition was withdrawn at 30 days. After 16 months follow-up, actual weight was 8.7 kg (percentile 10% to 25%). The patient remained on full enteral feedings.


CONCLUSIONS
In cases of intestinal atresia, short bowel syndrome, and proximal dilated bowel, we propose an aggressive surgical approach to preserve bowel mucosal surface while tailoring the jejunal loop to improve motility. The serial transverse enteroplasty procedure is an acceptable alternative to tailoring methods that resect a segment of the bowel wall.
Pediatric Surgery Division, Caba, Argentina; Center for Intestinal Transplantation and Rehabilitation, Caba, Argentina; Department of Pediatrics, Caba, Argentina; Department of Surgery, Caba, Argentina; Hospital Italiano de Buenos Aires, Caba, Buenos Aires, Argentina. Electronic address: pablo.lobos@hospitalitaliano.org.ar.
P A
PA
Lobos
Pediatric Surgery Division, Caba, Argentina; Department of Pediatrics, Caba, Argentina; Hospital Italiano de Buenos Aires, Caba, Buenos Aires, Argentina.
S E M
SE
Calello
Center for Intestinal Transplantation and Rehabilitation, Caba, Argentina; Department of Pediatrics, Caba, Argentina; Hospital Italiano de Buenos Aires, Caba, Buenos Aires, Argentina.
V B
VB
Busoni
Pediatric Surgery Division, Caba, Argentina; Department of Pediatrics, Caba, Argentina; Hospital Italiano de Buenos Aires, Caba, Buenos Aires, Argentina.
M M
MM
Urquizo Lino
Pediatric Surgery Division, Caba, Argentina; Department of Pediatrics, Caba, Argentina; Hospital Italiano de Buenos Aires, Caba, Buenos Aires, Argentina.
S G
SG
Prodan
Center for Intestinal Transplantation and Rehabilitation, Caba, Argentina; Department of Surgery, Caba, Argentina; Hospital Italiano de Buenos Aires, Caba, Buenos Aires, Argentina.
R
R
Sanchez Claria
D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012778:Short Bowel Syndrome / Q000601:surgery*