Outcomes of surgical management of intestinal atresias.

BACKGROUND: Outcome of managing intestinal atresias has improved in many developed countries, but most reports from low and middle income countries (LMICs) still show high morbidity and mortality. OBJECTIVE: The objective of the following study is to evaluate the outcome of surgically managed intestinal atresias in our health resource-limited setting. PATIENTS AND METHODS: All cases of intestinal atresias managed surgically from July 2007 to July 2012 were retrospectively analyzed. RESULTS: There were 23 patients comprised of 11 males and 12 females; 10 duodenal atresias (DA), 13 jejunoileal atresias (JIA) and no colonic atresias. The mean age at presentation to the surgeon was 10.3 days (range 2-43 days) for JIA and 10.6 days (range 1-35 days) for DA. Average weight at presentation was 2.2 kg for JIA and 2.4 kg for DA. Mean duration from presentation to surgery was 3.4 days for JIA and 4.8 days DA. All the JIA had primary repair; type 1 DA had duodenotomy and web excision while others had diamond duodenoduodenostomy. However one DA had duodenojejunostomy. 7 out of 10 DA patients (70%) had at least one associated anomaly, the most common being annular pancreas. There were 4 re-operations in JIA and none in DA (17.4% reoperation rate for 3 anastomotic leaks, 1 anastomotic stricture). Average hospital stay was 23 days for JIA and 12.3 days for DA. Overall, 5 (5) patients died (2 JIA and 3 DA) giving a mortality rate of 21.7%. Mortality rate for DA is 30% while for JIA is 15.4%. Causes of death were: Sepsis with disseminated intravascular coagulation (1), sepsis from anastomotic leakage (1), septic shock (1), anesthesia-related (1), undetermined (1). Two of the mortalities (40%) had re-operation for anastomotic leak. CONCLUSIONS: Short-term survival of neonates with intestinal atresias in our unit is still poor when compared with statistics from developed countries. Late presentation is common in this series, but does not appear to have negatively affected outcome. A high proportion of the mortalities had reoperation for anastomotic leak.