A systematic review on mechanical intestinal anastomoses in newborns and infants

Purpose. To analyze outcomes after putting the mechanical intestinal anastomoses in neonates and infants.
Material and methods. Two independent experts had searched the material in two scientific literature database PubMed and Elibrary using the following terms “stapled anastomosis-механический анастомоз», «children-дети» and have found 134 articles published in English (131 articles ) and in Russian (3 articles). All included articles were retrospective treatment series. The researchers selected only those publications in which patients’ age was less than 1 year, and the number of patients was more than 5.
Results. Out of 134 articles found in the initial search, only 7 articles were deemed eligible for this systematic review, accounting for a total of 352 patients who had mechanical intestinal anastomoses before 1 year of age with more than 5 follow-ups. The largest trial included 106 patients, the smallest one – 7 patients. The average weight of patients included in the systematic review was 4.2 kg. The average age was 4.9 months. Most often, a mechanical intestinal anastomosis was put to close the preventive enterostomy (99); then, intestinal atresia (70), necrotizing enterocolitis and spontaneous intestinal perforation (65), intestinal intussusception (30). The average duration of surgery was 85.5 min. Anastomotic leakage was noted in 11 patients. Rectal bleeding was observed in 9 patients. Anastomotic stenosis was recorded in 3 patients. Mortality rate was 1.7%. Unfavorable outcomes were not associated with surgery, but were caused by generalized bacterial infection (sepsis).
Conclusion. Mechanical intestinal anastomoses can be used in newborns and infants. The effectiveness of staplers has been confirmed by the low level of postoperative complications.