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.2016 Oct 10;5(4):45.
doi: 10.21699/jns.v5i4.474. eCollection 2016 Oct-Dec.

A Minor Innovation in Constructing a Small Bowel Stoma in Neonates with Small Bowel Atresia to Reduce the Morbidity

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A Minor Innovation in Constructing a Small Bowel Stoma in Neonates with Small Bowel Atresia to Reduce the Morbidity

Naeem Khan et al. J Neonatal Surg..

Abstract

Background: Intestinal atresia has still significant morbidity in developing countries. Stomas are now not recommended in every case of intestinal atresia; primary anastomosis is the goal of surgery after resection of dilated adynamic gut. A new type of stoma formation along with primary anastomosis is being presented here.

Materials and methods: This report is based on our experience of many cases with this technique in last 12 years but all the details and long follow-up of each case is not available. However the method of surgical procedure, progress, complications, and advantages encountered have been highlighted.

Results: Presently we have data of 7 patients; others are lost to follow up. Three had died with other associated problems, namely one with multiple atresias, two with septic shock and prematurity. Two stomas did not require formal closure because stoma shriveled and disappeared. Two other stomas had grown very long like a diverticulum when these were closed after 5 and 8 months.

Conclusion: This technique is another attempt to decrease morbidity of patients of intestinal atresia especially in those cases where short bowel syndrome is feared after resection of proximal dilated gut.

Keywords: Chimney; Intestinal atresia; Morbidity; New modification.

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Figures

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Figure 1: Jejunal Atresia, ideal for such technique.
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Figure 2: GIA auto stapler linear cutter is used to divide the proximal dilated portion of an intestinal atresia which divided it into V-shaped two conduits. The entire suture line is reinforced with additional layer of manual suturing with Vicryl/PDS 5/0.
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Figure 3: Showing the mesenteric conduit has been used to restore bowel continuity with the distal part of bowel atresia. The antimesenteric part is ready to bring out as enterostomy. The distal dusky portion will be excised leaving behind only 2.3cm of conduit.
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Figure 4: Antimesenteric bowel conduit after stoma formation.
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Figure 5: Appearance of stoma after few months of operation.
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Figure 6: Sometimes conduit undergoes excessive growth in length. On the other hand, if the blood supply is inadequate it may shrivel and get stenosed.
See this image and copyright information in PMC

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References

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    1. Federici S, Sabatino MD, Domenichelli V, Straziuso S. Worst prognosis in the "Complex" jejunoileal atresia: is it real? Eur J Pediatr Surg Rep. 2015; 3:7-11. - PMC - PubMed
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