Clinical characteristics and management of reoperation for high jejunal atresia: a retrospective study
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In brief
In brief
This retrospective study examines 16 neonates requiring reoperation after high jejunal atresia repair, identifying functional ileus (43.6%) as the leading cause, followed by anastomotic stenosis and adhesive complications. The authors recommend wider bowel resection for functional obstruction and careful inspection for proximal septa during initial surgery to reduce reoperation rates.
- Functional ileus is the most common cause of reoperation after high jejunal atresia repair (43.6% of cases in this series).
- Surgeons must carefully inspect for proximal jejunal septa during initial repair to avoid missed pathology requiring reoperation.
- For postoperative functional obstruction, wider bowel resection with re-anastomosis may be necessary to achieve adequate function.
- Reoperation indications include functional ileus, anastomotic stenosis, adhesive obstruction, and missed proximal septa.
- Most patients (87.5%) recover well after reoperation with good long-term growth, though short-bowel syndrome remains a risk.
Written by the GCMD Library team from the article.
Abstract
Objective
To analyze the clinical characteristics and available treatment strategies for reoperation of neonatal high jejunal atresia, and recommend preventive measures to reduce the reoperation rate of high jejunal atresia.
Methods
The clinical data of 16 children with high jejunal atresia who underwent reoperation in the Neonatal Surgery Department at Children’s Hospital of Zhejiang University School of Medicine from January 2018 to January 2023 were retrospectively analyzed.
Results
Among the 16 unplanned reoperations, 7 (43.6%) were performed for functional ileus, 3 (18.8%) for anastomotic stenosis, 3 (18.8%) for adhesive ileus, and 3 (18.8%) for postoperative proximal septum. Surgical procedures for reoperations include duodenoplasty, resection and re-anastomosis of the original anastomosis, resection of the duodenal septum and enterolysis. Among the 16 patients, 1 had short-bowel syndrome that required repeated hospital admission for parenteral nutrition treatment, and 1 patient died of recurrent pneumonia and heart failure after surgery. The other 14 patients recovered from reoperation and were discharged. The patients were followed up from 1 month to 5 years after surgery, and showed good growth.
Conclusion
For children with high jejunal atresia, the operative procedure will vary according to each patient’s circumstances. If postoperative functional obstruction occurs, a wider range of bowel cutting and re-anastomosis can be performed. During the first operation, the diaphragm at the proximal end of jejunal atresia should not be missed.