Treatment strategies in the management of jejunoileal and colonic atresia
<b>BACKGROUND/PURPOSE:</b> The purpose of this prospective study was to review the operative findings, treatment strategies, as well as the results of management of 46 consecutive cases of jejunoileal and colonic atresia, managed over a 2-year period. <b> MATERIALS AND METHODS:<...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2006-01-01
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| Series: | Journal of Indian Association of Pediatric Surgeons |
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| Online Access: | http://www.jiaps.com/article.asp?issn=0971-9261;year=2006;volume=11;issue=2;spage=79;epage=84;aulast=Chadha |
| _version_ | 1818556185838616576 |
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| author | Chadha Rajiv Sharma Akshay Roychoudhury S Bagga Deepak |
| author_facet | Chadha Rajiv Sharma Akshay Roychoudhury S Bagga Deepak |
| author_sort | Chadha Rajiv |
| collection | DOAJ |
| description | <b>BACKGROUND/PURPOSE:</b> The purpose of this prospective study was to review the operative findings, treatment strategies, as well as the results of management of 46 consecutive cases of jejunoileal and colonic atresia, managed over a 2-year period. <b> MATERIALS AND METHODS:</b> There were 42 patients with jejunoileal atresia (JIA) and 4 with colonic atresia (CA). The 4 group types were: type I-membranous (n=20), type II- blind ends separated by a fibrous cord (n=6), type IIIa- blind ends with a V-shaped mesenteric defect (n=10), type IIIb- apple-peel atresia (n=4) and type IV- multiple atresias (n=6). Primary surgery for JIA consisted of resection with a single anastomosis (n=37), anastomosis after tapering jejunoplasty (n=3), multiple anastomosis (n=1) and a Bishop-Koop ileostomy (n=1). For CA, resection with primary anastomosis was performed. A single end-to-oblique anastomosis after adequate resection of dilated proximal bowel, was the preferred surgical procedure. In the absence of facilities for administering TPN, early oral/nasogastric (NG) tube feeding was encouraged. In patients with anastomotic dysfunction, conservative treatment of the obstruction followed after its resolution by gradually increased NG feeds, was the preferred treatment protocol. <b> RESULTS:</b> Late presentation or diagnosis with hypovolemia, electrolyte imbalance, unconjugated hyperbilirubinemia (n=25) and sepsis (n=6), were significant preoperative findings. After resection and anastomosis, significant shortening of bowel length was seen in 16 patients (34.7%). Postoperative complications included an anastomotic leak (n=3), a perforation proximal to the anastomosis in 1 and anastomotic dysfunction in 5 patients. Full oral or NG tube feeding was possible only by the 13th to 31st postoperative day (POD), after the primary surgery in patients with anastomotic dysfunction and those undergoing reoperation. Overall, 38 patients survived (82.6%). Mortality was highest in patients with type IIIb or type IV JIA. <b> CONCLUSIONS:</b> Despite lack of ideal facilities for neonatal intensive care and administration of TPN, good results were achieved in the management of JIA and CA by following these principles: (1) adequate preoperative resuscitation, (2) meticulous surgical technique and a standardized surgical protocol, (3) early recognition of postoperative complications and their management by a uniform protocol and (4) wherever possible, early institution of oral or NG feeds, preferably by breast milk. |
| first_indexed | 2024-12-13T23:44:08Z |
| format | Article |
| id | doaj.art-0f72d6218ad64fc199dc8a22553832df |
| institution | Directory Open Access Journal |
| issn | 0971-9261 |
| language | English |
| last_indexed | 2024-12-13T23:44:08Z |
| publishDate | 2006-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
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| series | Journal of Indian Association of Pediatric Surgeons |
| spelling | doaj.art-0f72d6218ad64fc199dc8a22553832df2022-12-21T23:27:04ZengWolters Kluwer Medknow PublicationsJournal of Indian Association of Pediatric Surgeons0971-92612006-01-011127984Treatment strategies in the management of jejunoileal and colonic atresiaChadha RajivSharma AkshayRoychoudhury SBagga Deepak<b>BACKGROUND/PURPOSE:</b> The purpose of this prospective study was to review the operative findings, treatment strategies, as well as the results of management of 46 consecutive cases of jejunoileal and colonic atresia, managed over a 2-year period. <b> MATERIALS AND METHODS:</b> There were 42 patients with jejunoileal atresia (JIA) and 4 with colonic atresia (CA). The 4 group types were: type I-membranous (n=20), type II- blind ends separated by a fibrous cord (n=6), type IIIa- blind ends with a V-shaped mesenteric defect (n=10), type IIIb- apple-peel atresia (n=4) and type IV- multiple atresias (n=6). Primary surgery for JIA consisted of resection with a single anastomosis (n=37), anastomosis after tapering jejunoplasty (n=3), multiple anastomosis (n=1) and a Bishop-Koop ileostomy (n=1). For CA, resection with primary anastomosis was performed. A single end-to-oblique anastomosis after adequate resection of dilated proximal bowel, was the preferred surgical procedure. In the absence of facilities for administering TPN, early oral/nasogastric (NG) tube feeding was encouraged. In patients with anastomotic dysfunction, conservative treatment of the obstruction followed after its resolution by gradually increased NG feeds, was the preferred treatment protocol. <b> RESULTS:</b> Late presentation or diagnosis with hypovolemia, electrolyte imbalance, unconjugated hyperbilirubinemia (n=25) and sepsis (n=6), were significant preoperative findings. After resection and anastomosis, significant shortening of bowel length was seen in 16 patients (34.7%). Postoperative complications included an anastomotic leak (n=3), a perforation proximal to the anastomosis in 1 and anastomotic dysfunction in 5 patients. Full oral or NG tube feeding was possible only by the 13th to 31st postoperative day (POD), after the primary surgery in patients with anastomotic dysfunction and those undergoing reoperation. Overall, 38 patients survived (82.6%). Mortality was highest in patients with type IIIb or type IV JIA. <b> CONCLUSIONS:</b> Despite lack of ideal facilities for neonatal intensive care and administration of TPN, good results were achieved in the management of JIA and CA by following these principles: (1) adequate preoperative resuscitation, (2) meticulous surgical technique and a standardized surgical protocol, (3) early recognition of postoperative complications and their management by a uniform protocol and (4) wherever possible, early institution of oral or NG feeds, preferably by breast milk.http://www.jiaps.com/article.asp?issn=0971-9261;year=2006;volume=11;issue=2;spage=79;epage=84;aulast=ChadhaJejunoileal atresiacolonic atresiatotal parenteral nutrition |
| spellingShingle | Chadha Rajiv Sharma Akshay Roychoudhury S Bagga Deepak Treatment strategies in the management of jejunoileal and colonic atresia Journal of Indian Association of Pediatric Surgeons Jejunoileal atresia colonic atresia total parenteral nutrition |
| title | Treatment strategies in the management of jejunoileal and colonic atresia |
| title_full | Treatment strategies in the management of jejunoileal and colonic atresia |
| title_fullStr | Treatment strategies in the management of jejunoileal and colonic atresia |
| title_full_unstemmed | Treatment strategies in the management of jejunoileal and colonic atresia |
| title_short | Treatment strategies in the management of jejunoileal and colonic atresia |
| title_sort | treatment strategies in the management of jejunoileal and colonic atresia |
| topic | Jejunoileal atresia colonic atresia total parenteral nutrition |
| url | http://www.jiaps.com/article.asp?issn=0971-9261;year=2006;volume=11;issue=2;spage=79;epage=84;aulast=Chadha |
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