ABSTRACT
Objective To discuss the efficacy of transumbilical single-incision laparoscopic surgery for neonatal congenital intestinal atresia.Methods A retrospective analysis was conducted on data of 27 children admitted to our hospital from September 2019 to September 2022 who underwent transumbilical single-incision laparoscopic assisted surgery.A curved incision on the right side of the umbilicus to 1/2 circumference was made.A 3.5 cm disposable single hole multi-channel port(Port)was inserted.The intestinal atresia was located under direct vision.The proximal hypertrophic intestinal tube was removed,and the distal intestinal tube to the mesenteric side was cut open.Intermittent single layer suture with 5-0 absorbable suture was performed for end-oblique incision anastomosis.Then the CO2 pneumoperitoneum was established,and the entire abdominal cavity was observed to deal with combined deformities.Results The surgery was successfully completed in all the 27 patients,without conversion to open surgery.During the surgery,15 cases of jejunal atresia and 12 cases of ileal atresia were confirmed.There were 8 cases of type Ⅰ,5 cases of type Ⅱ,12 cases of type Ⅲa,and 2 cases of type Ⅲb.During the surgery,there were 5 cases of meconium peritonitis,1 case of biliary atresia,2 cases of intestinal malrotation,1 case of Meckel's diverticulum,2 cases of cryptorchidism,and 1 case of inguinal hernia.The median surgical time was 110.0(90.0,122.5)min.The median postoperative feeding time was 11.0(7.0,14.5)d.No anastomotic leakage occurred.The median postoperative hospital stay was 18.0(15.0,33.5)d.One child underwent the second surgery.A total of 22 cases were followed up for 0.5-4 years(average,2.3 years)without re-operations.Conclusions Transumbilical single-incision laparoscopic surgery for neonatal congenital intestinal atresia is scarless and easy to operate.Combined with the use of a Port,it can reduce intestinal compression and facilitate traction.Laparoscopy can simultaneously handle combined deformities.
ABSTRACT
Seventy neonates with congenital intestinal atresia and stenosis who were treated at pediatric surgical service, Hanyang University Hospital from September 1979 to December 1996 were analyzed retrospectively. The lesion occurred in 27 cases at the duodenum, in 26 cases at the jejunum, in 13 cases at the ileum, and in 2 cases at the pylorus and colon each. The atresia predominated over the stenosis by the ratio of 4 : 1. Male to female ratio was 1.3 : 1. The average gestational age was 38 weeks, and the average birth weight was 2,754 grams. Though 22.9% were borne prematurely and 34.3% had low birth weight, 92.3% of them had a weight appropriate for gestational age. The clinical manifestations were bile-stained vomiting (70%), abdominal distention (35.7%), jaundice (37.1%), and delayed passage of meconium (51.4%). Polyhydramnios (40%) was more frequently observed in duodenal and jejunal atresia while microcolon in ileal atresia (58.3%). Weight loss and electrolyte imbalance occurred more frequently in the duodenal stenosis cases because of delayed diagnosis. Twenty (55.6%) of 37 jejunoileal atresia cases had evidence of intrauterine vascular accident : 4 intrauterine intussusception, 3 intrauterine volvulus and 3 strangulated intestine in gastroschisis, and 10 cases of intrauterine peritonitis. There were one or more associated anomalies in 45 patients (64.3%). Preoperatively proximal loop volvulus developed in 3 cases and proximal loop perforation in 5 cases and one case each of distal loop perforation, duodenal perforation and midgut volvulus occurred in the jejunoileal atresia. There were 10 multiple atresia cases and 14 short bowel cases. Overall mortality rate was 20%.