257 Treatment of jejunoileal atresia by primary anastomosis or enterostomy Chapter 12 Introduction Treatment of jejunoileal atresia often results in severe postoperative complications such as small bowel syndrome, adhesive obstructions and anastomotic leakage or stenosis (1-5). Compared to earlier reports, the advances made in perioperative treatments (e.g. parenteral nutrition) and surgical techniques (e.g. intestinal tapering in case of luminal size discrepancies) seem to have led to a decrease in the occurrence of these complications and thereby a decrease in mortality (2-8). However, the occurrence of anastomotic leakage is still reported to occur in 8 – 22% of the patients in recent reports (3-5, 7, 9). Jejunoileal atresias are usually treated by either primary anastomosis or (a temporary) double barrelled enterostomy. The decision between both treatment strategies is mostly based on the clinical status of the patient and surgeons preference. The main reason for enterostomy creation is intestinal perforation or meconium peritonitis, but a prime reason to develop an enterostomy instead of a primary anastomosis is the fear of anastomotic leakage. However, enterostomy formation in paediatric cases in general is associated with multiple short- and long-term complications such as surgical site infections, incisional hernia and adhesive small bowel obstruction resulting in the use of extra antibiotic treatment or even repeated or emergency surgery (10, 11). As performing a double barrelled enterostomy in patients with jejunoileal atresia demands a second operation, the enterostomy reversal, the patient is exposed twice to the risk of developing postoperative complications. Additionally, repeated anaesthesia at this early age might have a lasting neurotoxic effect on the brain which could lead to long-term side-effects(12). Enterostomy development might therefore result in a higher overall risk of complications. Previous studies have evaluated the risk of complications following primary or secondary anastomosis during enterostomy reversal, yet no study has also taken the risks of complications from enterostomy formation (3, 4, 7). Therefore the aim of this study is 1) to compare the occurrence of severe postoperative complications (defined as Clavien-Dindo ≥III) and 2) to compare the occurrence of different short- and long-term complications following primary anastomosis or the combined enterostomy procedures. Method Study design and patient selection All consecutive patients treated for jejunoileal atresia between January 1998 and February 2021 at the Amsterdam university medical centres, two tertiary paediatric surgical centres, were retrospectively included from the surgical administrative database. All patients were treated by one group of paediatric surgeons working in both hospitals. Our data managers
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