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ORIGINAL ARTICLE
Year : 2013  |  Volume : 10  |  Issue : 3  |  Page : 222-225

Supra-transumbilical laparotomy (STL) approach for small bowel atresia repair: Our experience and review of the literature


1 Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
2 Department of Pediatric Anaesthesiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy

Correspondence Address:
Ernesto Leva
Department of Paediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Padiglione Alfieri (Chirurgia Pediatrica), Via Commenda-10 20122 Milano
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.120881

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Background: Supra-Transumbilical Laparotomy (STL) has been used in paediatric surgery for a broad spectrum of abdominal procedures. We report our experience with STL approach for small bowel atresia repair in newborns and review previous published series on the topic. Patients and Methods: Fourteen patients with small bowel atresia were treated via STL approach at our Institution over a 5-year period and their charts were retrospectively reviewed. Results: STL procedure was performed at mean age of 3.1 day. No malrotation disorders were detected with pre-operative contrast enema. Eight patients (54.1%) presented jejunal atresia, five (35.7%) ileal atresia, and one (7.1%) multiple ileal and jejunal atresias. Standard repair with primary end-to-back anastomosis was performed in all but one patient. In the newborn with multiple atresia, STL incision was converted in supra-umbilical transverse incision due to difficulty of exposition. After surgery, one patient developed anastomotic stricture, and another developed occlusion due to adhesions: Both infants required second laparotomy. No infections of the umbilical site were recorded, and cosmetic results were excellent in all patients. Conclusions: Increasing evidence suggests that STL approach for small bowel atresia is feasible, safe and provides adequate exposure for small bowel atresia surgery. When malrotation and colonic/multiple atresia are pre-operatively ruled out, STL procedure can be choosen as first approach.


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