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Medicine (Baltimore). 2019 May;98(19):e15459. doi: 10.1097/MD.0000000000015459.

Bowel plication in neonatal high jejunal atresia.

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Department of Surgery, Children's Hospital of Fudan University, Shanghai, China.


This study aimed to evaluate the efficacy of bowel plication as a part of the surgical treatment in neonatal high jejunal atresia.Between January 2013 and December 2016, 43 neonates with high jejunal atresia underwent surgical treatment at the Children's Hospital of Fudan University. According to the surgical procedures the patients underwent, the neonates were divided into a bowel plication group and a nonplication group. Eighteen neonates underwent proximal bowel plication after atretic segment resection and primary anastomosis. The other 25 neonates were in the nonplication group and underwent enteroplasty after atretic segment resection. Data were retrospectively analyzed, including gestational age, birth weight, concomitant diseases, age at surgery, duration of operation, length of total parenteral nutrition (TPN), postoperative intestinal function recovery (i.e., the time of the 1st oral feeding and when the oral feeding volume reached 40 mL/kg/3 h), length of hospital stay, growth and development, complications, and reoperations.No differences in gestational age, birth weight, concomitant disease, age at surgery, or duration of operation were found between the 2 groups. The time of the 1st oral feeding, the time when oral feeding volume reached 40 mL/kg/3 h, and duration of TPN for the bowel plication group were shorter than those for the nonplication group (9.4 ± 3.1, 14.6 ± 2.3, 9.2 ± 2.7 days, respectively, vs 13.5 ± 2.6, 17.6 ± 2.8, 14.3 ± 2.4 days, respectively, P < .05). The length of the hospital stay for the bowel plication group was significantly shorter than for the nonplication group (15.3 ± 3.1 days vs 18.5 ± 3.6 days, respectively, P < .05). In the bowel plication group, 1 patient (5.6%) underwent reoperation for intestinal stenosis resulting from neonatal necrotizing enterocolitis 1 year after the initial surgery. However, in the nonplication group, 5 patients (20%) underwent reoperation, including 3 for anastomotic stenosis and 2 for adhesive intestinal obstruction. Follow-up visits occurred for an average period of 2.8 years (6 months to 4.5 years). All infants thrived, and no differences in growth and development were found between the 2 groups.Bowel plication after atretic segment resection and primary anastomosis improves the clinical outcome for neonates with high jejunal atresia.

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