Original article
Preserving bowel length with a transluminal stent in neonates with multiple intestinal anastomoses: a case series and review of the literature

https://doi.org/10.1016/j.jpedsurg.2011.01.011Get rights and content

Abstract

Background/purpose

In neonatal surgery, preserving small bowel length is important to avoid short bowel syndrome. Our aim was to assess the outcomes of intraluminal stenting of neonatal multiple intestinal anastomoses.

Methods

We conducted a retrospective review of 9 patients (5, single institution; 4, published literature) who received multiple anastomoses stented by a silicon tube. Demographics, surgical anatomy and complications, nutritional outcomes, and follow-up were reviewed.

Results

Diagnosis was multiple intestinal atresias in 8 patients and necrotizing enterocolitis in 1. A silicon catheter entered either the mucous fistula (5 patients received a jejunostomy/mucous fistula) or a proximal opening on the dilated bowel and was threaded through viable segments of the bowel. The bowel ends were approximated. Stent was externalized in 7 patients. Final mean small bowel length was 63.9 cm. All complications (3 patients, leak/stricture) required surgery. Mean time to stent removal, feeds initiation, and parenteral nutrition (PN) discontinuation was 31.2 days, 17.3 days, and 159 days, respectively. Only 1 patient remains on PN (mean follow-up, 25.4 months).

Conclusions

Multiple intestinal anastomoses stenting is an excellent technique to avoid short bowel syndrome in the setting of multiple viable segments of gut, such as type IV intestinal atresia or necrotizing enterocolitis. Both our experience and the published literature show no mortality and PN-free survival.

Section snippets

Methods

We conducted a retrospective chart review of 5 patients who underwent multiple intestinal anastomoses stented by a transluminal tube. In addition, a literature review was performed using PubMed. The search dated back to 1966 and used the search terms of multiple intestinal atresias, stent, and SBS. The search was limited to the English language, and reports from both controlled trials and observational study designs were included. The search produced 4 case reports with adequate data to be

Demographics

Mean gestational age and birth weight of the cohort was 35 weeks (range, 33-40 weeks) and 2550 g (range, 1860-3560 g), respectively. Diagnoses included MIA (5-23 atresias, some of them with associated webs) in 8 patients (1 associated with gastroschisis) and NEC, with patchy small bowel involvement in 1 patient. Patient characteristics are summarized in Table 1.

Surgery

The first step of the operation was to determine viability of the bowel segments. The patient with NEC required a resection of 59 cm of

Discussion

Short-bowel syndrome is a major complication after intestinal surgery in neonates. Necrotizing enterocolitis and intestinal atresia play a significant role in the etiology of SBS in children [6].

In a series of 128 patients with jejunoileal atresia (24% type IV atresia), described by Dalla Vechia et al [7] in 1986, 25% of patients developed SBS, and most of them had type IIIb (apple-peel) or type IV atresia. The overall mortality was 16%, and it was related to long-term PN dependence in all

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