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Tapering Enteroplasty °d AJ-7~ "8"J

Ell

...,

Clinical Experience of Tapering Enteroplasty Using GIA Stapler in Je junoileal A tresias

Young Tack Song, M.D.

Department of Surgery, Catholic University Medical College Seoul, Korea

Jejunal and ileal atresias are the most common cause of congenital intestinal ob- struction and accounts for about 1/3 of all cases of intestinal obstruction in new- borns.

Despite the relative frequency of this anomaly, its survival rate was less than 10%

up to 1950, more recently the survival rate has risen rapidly to 90% with the intro- duction of modern surgical techniques and the use of total parenteral nutrition.

In 1969 Thomas described a tapering jejunoplasty to manage the discrepancy in the size of the proximal dilated lumen & contracted distal lumen, and to preserve absorptive surface when the dilated jejunum involved a long length, and Grosfeld et al.(l979) facilitated this method by using GIA staplers.

Author have also used GIA stapler to resect the antimesenteric portion of the di- lated proximal bowel in 8 cases of jejunoileal atresias with good results.

The following results were obtained;

1.

There we 3 jejunal atresias & 5 ileal atresia s, and male to female sex ratio was 5 : 3.

2. The type of atresia was as follows; type lIla was 3 cases, type lIIb was 4 cases, type IIIb+ IV was 1 case.

3. In non- complication cases(5 cases), the mean hospital day was 16 days, and oral feeding was feasible from 6.2 days after operation.

4. The complications(anastomotic leakage, pneumonia) were frequently occurred in type IIIb cases and in low birth weight cases(75%).

5. Mortality rate was 25% including DAMA(discharge against medical advice) dis- charge case.

Index Words

:

Tapering ente roplasty,

Jejunoileal atresia

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Table 1.

Summary of Non-Complication Cases

Age Sex B.W

(kg) Gest. Type Site

2D M 3.5 41 IlIa Jejunum

NSD

2D M 3.04

.38

IIlb+ IV Ileum

NSD

5D M 2.3 39+

⁵

IlIa Jejunum

NSD

2D F 3.26 39+4 IlIb Ileum

NSD

4D M 2.74 38 lIla Ileum

Rc/sD

Table 2.

Summary of Complication

&

Death Cases

Age Sex B.W

(kg) Gest. Type Site

7D F 1.9 37+

³

I1Ib Jejunum

NSD

2D F 1.53 31+

³

IIIb Ileum

PSD

6D M 2.45 38+

⁴

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Ileum

NSD

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Discharge day

Remarks Feeding

(B.W)

7 17

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6 22

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6 18

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6 12 maternal sono

(2.92) 29+

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6 11

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Discharge day Complication Feeding

(B.W)

&

Remarks Re-op Re-op 44th

8th day (2.12) *

**

Re-op Re-op 26th anastomosis 7th day (2.85)

leakage

* ^{Re-op at} 11th day; functional obstruction after end to back anastomosis. DAM A discharge at re -op 44th day-sepsis due to long-term hyperalimentation

** Post-op pneumonia; ventilatory care, expired at post-op 20th day, intraventricular

hemorrhage.

Diagnosed by maternal sono at 31

+,

wks

Fig. 1. The antimesenteric portion of dilated proximal loop was resected using GIA stapler after apply- ing No. 10 Nelaton catheter along the mesenteric side.

Fig. 2. This photo shows completed end to end, single layer anastomosis using

5-0

Vicryl sutures.

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.

1. Foglia RP, Jobst S, Fonkalsrud EW, et al : An unusual variant of a jejunoileal atresia.

J Pediatr Surg 18 : 182-184, 1983

2. Fockens P : Ein operativ geheilter fall von kongenitaler duennd atresie. Zentralbl Chir 38: 531, 1911

:3f~. 91:v1-~§j7.]

41: 439-448,1991 4. Touloukian RJ : Diagnosis and treatment of

jejunoileal atresia. World J Surg 17 : 310- 317, 1993

5.

~~7],

7;>l%oJ:

~~Pcl

AJlll]±ll

~ ~3j-~

: 5601] 01] t:J1

~ ~~ ~ 91:i1}~

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1993

6. Louw JH : Congenital atresia and stenosis of the small intestine. The case for resection and primary end to end

anastomosis.

S Afr J Surg 4 : 54 - 64, 1966

7. Nixon HH: Intestinal obstruction in the newborn. Arch Dis Child 30 : 13-22,1955 8. de Lorimier AA, Norman DA, Gooding CA,

et al : A model for the

cinefluoroscopic

and manometric study of chronic intestinal ob- struction. J Pediatr Surg8 : 785-791, 1973 9. Cloutier R: Intestinal smooth muscle

resp~nse

to chronic obstruction: possible application in jejunoilea l atresia. J Pediatr

..

Surg 10 : 3-8, 1975

10. Haller JA, Tepas JJ, Pickard LR, et al : In- testinal atresia, current concepts of patho- genesIs, pathophysiology, and operative management. Am Surgeon 49 : 385,1983 11. de Lorimier AA, Fonkalsrud EW, Hays DM

: Congenital atresia and stenosis of the je- Junum and ileum. Surgery 65: 8 19-827, 1969

12. Thomas CG Jr, Carter JM : Small intestinal atresia: The critical role of a functioning anastomosis. Ann Surg 179 : 663-670, 1974 13. Howard ER, Othersen HB: Proximal

jejunoplasty in the treatment of jejunal atre- sia. J Pediatr Surg 5 : 685-689, 1973 14. Grosfeld JL, Ballantine TVN, Shoemaker R

: Operative management of intestinal atre- sia and stenosis based on pathologic findings. J Pediatr Surg 14 : 368-375, 1979 15. de Lorimier AA, Harrison MR : Intestinal

plication in the treatment of atresia. J Pediatr Surg 18 : 734-737. 1983

16. Weber TR, Van DW, Grosfeld JL : Taper- ing enteroplasty in infants with bowel atre- sia and short gut. Arch Surg 117 : 684-688, 1982

17. Rescorla FJ, Grosfeld JL : Intestinal atresia and stenosis: Analysis of survival in 120 cases. Surgery 98 : 668-676, 1985

18. AcJ "'j.'?:-,

\:t~~, li}'f1~,

et al :

{i ;~Fj ~

AJ

JllVJl%.

91.llj-~§jAl

42: 81-86, 1992