Abstract
Purpose
We aimed to compare the outcomes of primary anastomosis (PA) and enterostomy as treatments for intestinal atresia in neonates to identify the factors influencing the choice of modality.
Methods
We conducted a retrospective single-centre analysis of all neonates with intestinal atresia between 2000 and 2020 and measured the clinical outcomes. We performed logistic regression to identify factors that influenced the choice of surgical approach.
Results
Of 62 intestinal atresia neonates, 71% received PA. There were no significant differences in gestation, gender, age at operation, birth weight, or body weight at operation between the PA and enterostomy groups. PA reoperation was not required for 78% of patients, and the PA group had shorter hospital stays. Complications, operative time, duration on parenteral nutrition, time to full enteral feeding were comparable in both groups. Upon multivariate regression analysis, surgeons favoured PA in proximal atresia [Odds ratio (OR) 38.5, 95% Confidence Interval (CI) 2.558–579] while enterostomy in smaller body size [OR 2.75, CI 0.538–14.02] and lower Apgar score [OR 1.1, CI 0.07–17.8]. Subgroup analysis in these patient groups demonstrated comparable outcomes with both surgical approaches.
Conclusion
Both surgical approaches achieved comparable outcomes, but PA was associated with short hospital stays and the avoidance of stoma-related complications, and reoperation was generally not required. This surgical approach was suitable for patients with proximal atresia, but enterostomy remained a sensible choice for patients with smaller body sizes and lower Apgar scores.
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Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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Fung and Lee contributed equally as the co-first author. Fung, Lee, Lui, and Lip prepared the data and wrote the main text. All the authors contributed the idea of the research and reviewed the manuscript.
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Fung, A.C.H., Lee, M.K., Lui, M.P.K. et al. Primary anastomosis is the preferred surgical approach for proximal intestinal atresia: a retrospective 20-year analysis. Pediatr Surg Int 39, 99 (2023). https://doi.org/10.1007/s00383-023-05383-4
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DOI: https://doi.org/10.1007/s00383-023-05383-4