[Application of laparoscopy in the diagnosis and treatment of neonates and infants with congenital intestinal atresia and stenosis].

OBJECTIVE: To investigate the feasibility and efficacy of laparoscopic procedure in the diagnosis and treatment of congenital intestinal atresia and stenosis in neonates and infants.

METHODS: Between September 2009 and September 2013, 55 cases with intestinal atresia and stenosis underwent laparoscope-assisted procedures in our department. There were, 32 males and 23 females, Twelve cases were diagnosed as duodenal atresia and stenosis and 43 as intestinal atresia and stenosis. The age at hospitalization was 7 minutes to 7 months(mean 9.88 d). After the diagnosis by multiport or transumbilical single-site laparoscopic exploration, cases with duodenal atresia and stenosis and part of the cases with proximal jejunum were treated by laparoscopic operations to remove the septum and restore intestinal continuity. In other cases with intestinal atresia and stenosis, laparoscopic inspection was performed to make diagnosis and then the proximal and distal ends of the atresia were exteriorized through the umbilical port site for end-to-oblique anastomosis.

RESULTS: All the 55 cases underwent this minimally invasive approach, and no case was converted to open surgery. The operative time of laparoscopic procedure for duodenal atresia and stenosis (n=12) ranged from 80 to 145 min(mean, 110 min). During the follow-up of 3-34 months, one case had recurrent postoperative vomiting induced by giant duodenal expansion above anastomotic stoma and died the second day after operation. The operative time of laparoscopic surgery for intestinal atresia and stenosis (n=43) ranged from 35 to 70 min (mean 46 min). During the follow-up of 3-36 months, 3 cases complicated with meconium peritonitis had postoperative short bowel syndrome and died. One case died of intestinal perforation at 3 month postoperatively. One case died of intestinal adhesion at 7 month postoperatively. The rest of cases had favorable outcomes.

CONCLUSION: Laparoscopic surgery for the diagnosis and treatment of intestinal atresia and stenosis has advantages of small incision, less trauma, and rapid recovery.