263 Treatment of jejunoileal atresia by primary anastomosis or enterostomy Chapter 12 In the group treated with a primary anastomosis one patient died due to sepsis caused by a pneumonia more than a year following surgery. This patient had multiple comorbidities including an omphalocele, tracheomalacia and pulmonary fibrosis caused by micro-aspirations. The second patient died following necrotizing enterocolitis and sepsis which was exacerbated by an iatrogenic perforation of the colon during a colonic enema performed before signs of NEC arose. The enema was given because of assumed constipation postoperatively. This patient also had multiple comorbidities including cortical dysplasia, hydrocephalus and hydronephrosis. Table 2 – Postoperative complications per operation per treatment group Outcome Primary anastomosis (Total = 48) Enterostomy formation (Total = 32) Enterostomy reversal (Total = 31)*1 (N=missing) (N=missing) (N=missing) Mean duration of surgery in minutes (std) 126 (38) (N=1) 116 (37) (N=3) 90 (34) Duration admission in median days (IQR) 33 (21 – 62) 50 (20 – 92) 17 (13 – 22)*2 Clavien-Dindo within 30 days None 17 (35%) 7 (23%) (N=1) 11 (36%) (N=1) Grade 1 0 2 (6%) 3 (10%) Grade 2 8 (26%) 5 (16%) 6 (20%) Grade 3 9 (19%) 12 (39%) 6 (20%) Grade 4 5 (10%) 4 (13%) 2 (7%) Grade 5 1 (2%) 1 (3%) 2 (7%) Surgical site infection 1 (2%) 4 (13%) (N=1) 4 (13%) (N=1) Wound dehiscence 1 (2%) 4 (13%) (N=1) 5 (17%) (N=1) Central catheter infection 18 (38%) 13 (42%) (N=1) 6 (20%) (N=1) Necrotizing enterocolitis 1 (2%) 1 (3%) (N=1) 0 Cholestasis 19 (40%) (N=4) 16 (52%) (N=1) 0 Anastomotic leakage 4 (9%) 0 3 (10%) (N=1) Anastomotic stenosis 8 (17%) 1 (33%)*3 8 (25%) (N=1) Adhesive obstruction 4 (8%) 0*3 8 (25%) Incisional hernia 1 (2%) 0 3 (9%) High-output enterostomy - 15 (48%) - Enterostomy prolapse - 7 (22%) - Other enterostomy related complications resulting in redo surgery - 5 (16%) - *1 = one patient died before enterostomy reversal *2 = based on the 11 patients (35%) who were readmitted for planned enterostomy reversal *3 = based on the 3 patients in whom an anastomosis was constructed
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