Management and Outcomes of Jejunoileal Atresia Within the United Kingdom

Abstract

Background: Jejunoileal atresia (JIA) is seen in 0.7 per 10,000 births and requires early surgical intervention to restore gastrointestinal continuity. Many intra-operative techniques exist to manage the atresia depending on anatomy encountered and proximal bowel dilatation. Existing studies are predominantly single centre experiences. This study aims to report contemporary management and outcomes of JIA in the United Kingdom (UK) and explore how operative technique is associated with outcome.

Methods: Multicentre UK based observational study over 5 years with follow-up to 1 year post surgery. Outcomes were time to full enteral feeds, length of stay, unplanned reoperation, number of general anaesthetics, development of short bowel syndrome and mortality. These outcomes were stratified by infant related, disease related and surgical technique related factors.

Results: There were 159 infants with JIA from seven tertiary paediatric surgical units. JIA was suspected antenatally in 92 (57.8 %) infants and associated congenital anomalies were seen in 47 (29.6 %) infants. Age at surgery was 2 (0-70) days and primary anastomosis was undertaken in 114 (71.7 %) procedures most commonly (87.9 %) via end-to-end anastomosis. Primary anastomosis was associated with shorter duration to full enteral feeds (21 vs 60 days, p = 0.001), shorter length of stay (28 vs 78 days, p < 0.001), fewer general anaesthetics (1 vs 3, p < 0.001) and lower mortality (0.9 vs 11.1 %, p = 0.002) than enterostomy formation. Overall, unplanned reoperation was required in 27 (17.0 %) infants primarily for intestinal obstruction (n = 21/27).

Conclusions: These data provide contemporary outcomes by atresia type and highlight obstructive complications are frequent in this cohort. These data support primary anastomosis in JIA.

Keywords: Enterostomy; Jejunoileal atresia; Neonatal surgery; Outcomes; Primary anastomosis.