40 years' review of intestinal atresia

Objective To analyze the 40 years' experience of intestinal atresia and to introduce a new design of long-oblique anastomosis for disproportional loop s of the intestine. Methods A total of 449 cases of congenital atresia of the small intestine w ere classified into three groups according to the embryopathology: high gro up (145 cases), including duodenal and high jejunal atresia; middle group ( 288), including ileo-jejunal atresia; and low group (16), including termina l ileal atresia. To analyze the survival rate and mode of treatment, we ass igned the cases into 3 groups according to the year of admission: 1) 1956 - 1969 (173 cases), under the general pediatric surgical care; 2) 1970 - 198 5 (147), under the specialty neonatal surgical care; and 3) 1986 - 1996 (12 9), with additional use of total parenteral nutrition. Results The ileojejunal atresia group (middle group) had the highest mortal ity rate (47.6%). The overall mortality rate decreased as the time went by, dropping from 64.7% in the early years down to 18.6% in the recent years, and no hospital death occurred in the recent couple of years. Conclusion Besides the improvement of neonatal surgical techniques, selecti ng a proper surgical procedure according to the embryopathology is essentia l to the reduction of mortality. The long-oblique anastomosis is particular ly acceptable in China at present for marked disproportional loops.