NEONATAL INTESTINAL-OBSTRUCTION - REDUCING SHORT-TERM COMPLICATIONS BY SURGICAL REFINEMENTS

Over the last ten years advances in neonatal intensive care, such as t he advent of parenteral nutrition, have led to a significant decrease in the mortality rates of neonates with intestinal obstruction. Nevert heless, surgical short-term complications associated with the intestin al anastomosis performed, such as stenosis or leakage, and long-term n utritional complications due to extensive resections ate still respons ible for mortality and for a high morbidity rate. 39 newborns referred to our hospital in the past 3 years for intestinal obstruction were r etrospectively evaluated with particular attention to the surgical man agement, surgical techniques and subsequent complications. Age on admi ssion was from 1 hour to 24 days; weight from 1.4 to 3.8 kg; 41% of ne wborns had a prenatal diagnosis. 57 surgical procedures were performed : among them 44 intestinal anastomoses. Short-term surgical complicati ons, namely perforation and stenosis, were observed in 18.1% of anasto moses. The complication rate after simple end-to-end anastomosis was a s high as 30%. However, certain technical refinements such as tailorin g the dilated upper pouch, positioning a transanastomotic feeding tube and an intubated lateral stoma resulted in a much lower complication rate (3.7%). Thus, in our experience these technical refinements are e ffective in reducing the incidence of short-term surgical complication s.