TITLE:
Review. Gastrointestinal Surgery in Neonates: Practice, Facts, and Trends
AUTHORS:
Ralf-Bodo Tröbs
KEYWORDS:
Neonatal Surgery, Acute Abdomen, Gastrointestinal Atresia, Necrotizing Enterocolitis, Bowel Obstruction
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.9 No.2,
June
18,
2019
ABSTRACT: The author presents an overview of the current trends in acute neonatal
gastrointestinal surgery. Necrotizing enterocolitis and focal intestinal
perforation are disorders of different etiology, appearance, and prognosis. In
neonates with focal perforation, a good prognosis can be expected. Primary anastomosis
is a valid option for primary surgery. Meconium ileus is based on obstruction
of the terminal ileum. Medical treatment is the primary therapeutic option,
although surgery may be required. In contrast, meconium plug syndrome is based
on stool plugging in the left colon, and surgery is not appropriate.
Hirschsprung’s disease is confirmed on the basis of representative biopsy of
the rectum just above the dentate line. There is a trend toward a single-step
pull-through operation without protective stoma. Open hernia repair in small
neonates can be performed via a mini-incision and without opening the external
inguinal ring. Laparoscopic hernia repair has some advantages, especially in
girls. In infants with pyloric stenosis, laparoscopic pyloromyotomy is a first
line option for treatment. There is a general trend toward single-stage
procedures and laparoscopic reconstructive surgery for gastrointestinal
malformations. With the exception of tracheoesophageal fistula and low bowel
obstruction, the vast majority of upper gastrointestinal malformations can be
identified using prenatal ultrasound examination. One-stage repair with
excellent results is even possible in neonates below 1000 g. Surgery of
duodenal or small bowel atresia can be performed following the postnatal
adaptation period. For some forms of anorectal malformation, the need for a
protective stoma has been questioned in the last decade. Posterior sagittal anorectoplasty
remains the standard procedure for the majority of cases. Midgut or segmental
volvulus affects different groups of infants. If a neonate is suspected of
having any type of volvulus, urgent surgery is required. Intestinal duplication
carries a high risk for complications, and surgery should be performed on an
elective basis.