Multiple intestinal anastomosis in newborns and infants



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Abstract

Introduction. The present trial systematizes data, taken from one surgical center as an example, on treating patients with intestinal atresia and necrotizing enterocolitis with multiple intestinal anastomoses.

Material and methods. The trial is a retrospective review on the treatment of 13 newborn infants who since 2010 have been put multiple intestinal anastomoses; the treatment was approved by the Hospital Ethics Committee. The average gestational age of patients was 31.2 weeks. The average age at the time of surgery – 7,9 days. Average weight - 2007 grams. The average number of anastomoses was 3.7 (range: 2-7). The average length of remained small intestine after the second surgery was 67.4 cm (range: 12-120 cm). No other surgical procedures, including gastrostomy or enterostomy, were performed. In all cases, surgical intervention ended with hermetic suturing of the abdominal cavity. Among them, there were 6 patients with the multifocal form of necrotizing enterocolitis; 6 patients had type IV atresia of the small intestine; 1 patient had the Ladd’s syndrome. Connection of intestinal segments was made by constructing several “end-to-end” anastomoses, double-row precision seam with PDS II 7/0 suture.

Results. In the postoperative period, complications associated with anastomosis construction, such as leakage and narrowing, were not recorded. Transit function of the gastrointestinal tract restored on day 4, on average, after the surgery (range: 2-6 days). There were no early lethal outcomes within the first 28 days after the surgery which were associated with the surgery. 2 patients with short bowel syndrome (remained small intestine was 12 and 25 cm) and multivisceral disorders died on day 72 and 64 after the surgery. Survived patients were transferred to full enteral feeding in 56 days, in average, after the second surgery (range - 15-120 days).

Conclusion. In our study, we have demonstrated potentials of a new surgical approach: one-stage formation of multiple intestinal anastomoses in case of multiple intestinal atresias as well as in case of multifocal forms of necrotizing enterocolitis. Maintaining the bowel length with multiple bowel anastomoses is very important factor for better survival of patients with the short bowel syndrome.  

About the authors

Yu. A. Kozlov

Municipal Ivano-Matreninsky Children’s Clinical Hospital; Irkutsk State Medical Academy of Continuous Education; Irkutsk State Medical University

Author for correspondence.
Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-2313-897X

Yury А. Kozlov, MD, PhD, DSc, prof., head of newborn department in Municipal Ivano-Matreninsky Children’s Clinical Hospital, Irkutsk; professor at Irkutsk State Medical Academy of Continuous Education, Irkutsk, 664049

Россия

M. N. Mochalov

Municipal Ivano-Matreninsky Children’s Clinical Hospital; Irkutsk State Medical Academy of Continuous Education; Irkutsk State Medical University

Email: fake@neicon.ru

Irkutsk, 664009; Irkutsk, 664049; Irkutsk, 664003

Россия

K. A. Kovalkov

Kemerovo Clinical Pediatric Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0001-6126-4198

Kemerovo, 650056

Россия

S. S. Poloyan

Center for Maternity and Childhood Protection

Email: fake@neicon.ru
ORCID iD: 0000-0001-7042-6646

Krasnoyarsk, 660074 

Россия

P. Zh. Baradieva

Municipal Ivano-Matreninsky Children’s Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-5463-6763

Irkutsk, 664009

Россия

D. A. Zvonkov

Irkutsk State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0002-7167-2520

Irkutsk, 664003

Россия

Ch. B. Ochirov

Municipal Ivano-Matreninsky Children’s Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-6045-1087

Irkutsk, 664009

Россия

V. S. Cheremnov

Municipal Ivano-Matreninsky Children’s Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0001-6135-4054

Irkutsk, 664009

Россия

V. A. Stankeev

Irkutsk State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0002-8759-7887

Irkutsk, 664003

Россия

A. P. Rozhanski

Irkutsk State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0001-7922-7600

Irkutsk, 664003

Россия

S. Yu. Kozlov

Irkutsk State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0001-5834-1674

Irkutsk, 664003

Россия

Ya. P. Sandakov

Irkutsk State Medical Academy of Continuous Education

Email: fake@neicon.ru
ORCID iD: 0000-0002-3976-9509

Irkutsk, 664049

Россия

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