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Plication, End-To-End
Anastomosis and Transanastomotic Stent for Intestinal Atresia Type
IIIb (Apple Peel Deformity)
Ahmed Nofal
Unit of Pediatric
Surgery, Department of Surgery, Faculty of Medicine, Tanta
University, Egypt
Tanta Med. Sc. J 2008; 3(3):87-95
Article type: Original article
Background/Aim: Jejunoileal atresia is a common
cause of intestinal obstruction in the newborn. Five morphological
patterns of intestinal atresia are recognized: type I, type II, type
IIIa, type IIIb and type IV. Type IIIb "apple peel deformity" is a
complex form of intestinal atresia, and its management by the
traditional surgical technique, i.e. resection of the proximal
dilated segment and end-to-end anastomosis, could be complicated by
short bowel syndrome and/or postoperative obstruction. In the
present work, in order to avoid the possible complications of the
traditional technique, we have managed apple peel atresia by
plication, end-to-end anastomosis and insertion of a
transanastomotic stent, and the results were evaluated. Patient &
Methods: Over a period of 3 years, all the babies with intestinal
atresia referred to us were managed in the neonatal intensive care
unit (NICU) by insertion of a nasogastric/orogastric tube for GIT
decompression, fluid therapy, and prophylactic antibiotics, then
they were fully investigated and prepared for surgery. At
exploration, the cases with apple peel atresia were managed by
plication of the proximal dilated segment, end-to-end anastomosis
and insertion of a transanastomotic stent to keep the distal
intestinal segment in place & opened up. Postoperatively, the stent
was gradually withdrawn, and then completely removed within two
weeks. The patients were discharged from our side 2-4 weeks after
surgery and were followed-up for further evaluation. Results: The
present work included 6 cases of apple peel deformity; all of them
were sporadic with no family history of congenital gastrointestinal
anomaly. The mean gestational age and birth weight were 35.8 weeks
and 2675 g respectively. All the 6 babies presented with the
classical features of intestinal obstruction, and the congenital
anomaly of GIT was confirmed on abdominal x-rays. Intraoperatively,
the ileocecal valve and at least 90 cm of the small bowel could be
preserved in all cases. Postoperatively, we had no complications
related to stent insertion, and with the exception of the first
case, re-exploration was not required in our patients. During the
period of follow-up, all the babies showed normal growth with no
late complications. Conclusion: Management of apple peel atresia by
plication of the dilated proximal segment, end-to-end anastomosis
with insertion of transanastomotic stent has several advantages: it
preserves a maximal length of intestine, it avoids the possibility
of postoperative obstruction, as well as it facilitates early
introduction of enteral feeding through the stent.
ICID 871175
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