Laparoscopic anastomosis of the small intestine in the presence of atresia caused by intrauterine invagination

Abstract

Introduction. Intrauterine invagination is one of rare reasons that can result in small bowel atresia. The aim of the study is to demonstrate that laparoscopy can be used to treat the disease. Material and methods. The study describes an experience of endosurgical treatment of a patient with small bowel IIIA type atresia due to invagination that occurred in the prenatal period. The boy was premature; at the moment of birth his gestational age was 2 weeks and his weight was 1,280 g. Technical details of a surgical procedure along with its early and remote results were presented. Results. Intestinal atresia was operated on the 2 nd day of life. They used a soft carboperitoneum with the following carbon dioxide findings: flow of 1.5 L/min, pressure of 8 mm Hg. An optical port was installed into the left iliac region. Two other instrumental ports were located bilateral to the telescope ensuring the triangulation principle. Ileac atresia type IIIA located 8 cm away from the ileocecal valve was found during an abdominal examination. Closed ends of adducent and abducent bowels were resected. An additional formation in the form of an intrauterine intestinal invagination was found in a distal segment lumen during its resection. Completely laparoscopic intracorporeal intestinal anastomosis was performed. The surgery lasted 65 minutes. Enteral feeding was given on the 2 nd day of the surgery. Complete enteral feeding was restored on the 5 th day following the surgery. No signs of anastomotic leak were observed in the early observational period. The infant was discharged from the hospital when he was 28 days old and weighed 1,800 g. No signs of intestinal transit were found during 6 months of observation. Conclusion. Laparoscopic anastomosis performed at a children’s surgical center is an alternative to open surgery during the management of patients with small bowel atresia caused by intrauterine invagination. More extensive multicenter trials are required to determine the role of laparoscopy in treatment of this disease.

Keywords

small bowel atresia / intrauterine invagination / laparoscopy / newborns

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Kozlov Y.A., Rasputin A.A., Baradieva P.J., Ochirov C.B., Kapuller V.M., Cheremnov V.S.