Conservative intestinal surgery to avoid short-bowel syndrome in multiple intestinal atresias and necrotizing enterocolitis: 6 cases treated by multiple anastomoses and Santulli-type enterostomy

Neonates with multiple sites of intestinal atresia (MIA) may be predisposed to short-gut syndrome. Anastomoses of the intervening segments may prevent this complication. 5 neonates with MIA, one of them with a gastroschisis, were operated on: a proximal enterostomy was constructed, a side-to-end ana stomosis as described by Santulli and several end-to-end anastomoses betwee n the intervening intestinal segments (n = 3 to 7) were performed. An addit ional infant, initially operated on for a necrotizing enterocolitis (NEC) w as managed with the same surgical procedure. Without use of this technique, the remaining length of small intestine would have been 28, 27, 40, 58, 70 and 7 cm. This technique enabled an intestinal length of 49, 54, 96, 107, 92 and 93 cm respectively to be achieved, Ileocecal valve was present in al l 5 cases with MIA, but resected in the case with NEC. The enterostomy was reversed 7 weeks later. The initial outcome (delay of enteral feeding, dura tion of parenteral nutrition) was good: the babies were weaned from parente ral nutrition (PN) after a mean time of 90 days (48 to 163 days). The progn osis (mean follow-up:, 31 months, range 14 to 57) was good with regards to growth and development and length of time required before adaptation to nor mal enteral feedings and stools. This surgical method allows complete decompression of the proximal jejunum so that nutriment can pass into the distal bowel allowing it to enlarge. In cases of MIA, a long tapering proximal enteroplasty is a better procedure than resecting more than 5-10 cm of the proximal distended and hypertrophie d bowel. We prefer to perform an enterostomy in association with multiple a nastomoses between intervening intestinal segments. The enterostomy is pres erved for long enough waiting period to enable the reversion of the histoch emical and morphological changes that may have taken place in the bowel.