Small bowel atresia is a congenital disorder in which the small intestine (consisting of the jejunum and ileum) is not passable. This disease occurs either due to the absence of a part of the intestine (true "atresia") or due to a membrane that bulges into the intestine like a windsock. In some children, the disease is already detected during pregnancy during check-ups.

Small bowel atresia can only be treated by surgery. This involves either opening the intestine and severing the membrane or removing the short "misplaced" intestine and stitching the two parts of the small intestine together (jejunojejunostomy or ileoileostomy). If no other diseases are present (e.g. short bowel syndrome*), the individual prognosis for the patient is very good. Later operations or restrictions in daily life are generally not to be expected.

The term short bowel syndrome (KDS) describes a condition of impaired absorption of nutrients from the intestine due to various disorders in the gastrointestinal tract. The remaining function of the intestine is no longer sufficient for the child to thrive. KDS is also defined as dependence on parenteral nutrition (via a catheter inserted into a large vein) secondary to functional or anatomical loss of bowel function.

First, the newborn's abdomen is x-rayed in the Clinical Department. As the stomach and intestinal tract of the newborn fills with air after birth, air can only be seen up to the point where there is an interruption in the continuity of the intestine due to the atresia. As newborns with intestinal atresia vomit after drinking, a thin silicone tube ("feeding tube") is inserted through the nose. This drains the secretions (saliva, gastric juice, small intestinal secretions) that cannot flow into the small intestine further "downstream" due to the malformation of the intestine. Your child can usually be cared for on a normal ward before the operation, where one of the parents is with the child at all times. Only if your child has other malformations (e.g. severe heart defects) may it be necessary to care for him or her in our intensive care unit for maximum safety.

The operation is consistent. The part of the small intestine that lies in front of the atresia and is therefore also overstretched is connected to the very narrow part behind the missing section of intestine. The pediatric surgeon surgically adjusts the different widths of the two parts of the intestine. The operation is performed via an abdominal incision and can only be performed in very rare and selected cases via laparoscopy (laparoscopic and therefore minimally invasive). We will explain the advantages and disadvantages of the exact operation to you in detail before the operation and try to answer all your questions calmly.

 

Procedure of the operation:

We make an incision a few centimeters across the upper abdomen. The abdominal organs are then examined for further malformations. The two parts of the small intestine are exposed. The diseased part of the intestine (which is usually only a few centimetres long) is removed. The pediatric surgeon then stitches the two parts together. This connection is called an anastomosis or, in the case of small bowel atresia, a jejunojejunostomy or ileoileostomy. The suture is made of absorbable material. The stitches do not need to be removed later. Scarring depends on the individual's disposition. As the incision takes into account the so-called cleavage lines of the skin, the scars are often less visible later than expected.

Open surgery :
In the open (conventional) surgical technique, the pediatric surgeon makes an incision a few centimeters across the upper abdomen. The abdominal organs are then examined for further malformations. The two parts of the duodenum are exposed. The upper part is incised transversely, the lower part longitudinally. The pediatric surgeon then sutures the two parts together. This connection is called an anastomosis or, in the case of duodenal atresia, a duodenoduodenostomy. The suture is in the shape of a diamond and is made of absorbable material. The stitches do not need to be removed later. Scarring depends on the individual's disposition. As the incision takes into account the so-called cleavage lines of the skin, the scars are often less visible later than expected.

Minimally invasive surgery:
In this minimally invasive surgical technique, the pediatric surgeon makes a small incision in the navel through which he guides a thin tube (trocar) into the abdominal cavity. Air is blown into the abdominal cavity through the trocar and a camera is inserted (laparoscopy). This allows the entire abdomen to be inspected. The operation follows the same principle as the open procedure, except that three additional working channels (trocars) are inserted into the abdomen instead of the upper abdominal cross-section. The two parts of the duodenum are exposed and sutured together as in the open procedure. As there is no skin incision in the minimally invasive procedure, the cosmetic result is better than with the open procedure.
However, not all children can undergo minimally invasive surgery. The surgical technique depends on factors such as birth weight or other malformations (such as heart defects). The pediatric surgeon may also have to switch to the open surgical technique for technical reasons, for example if the overview during laparoscopy is inadequate.

Newborns with small bowel atresia must remain in hospital for between one week and several weeks after the operation, depending on concomitant illnesses and other factors (e.g. prematurity). If your child is not in the intensive care unit, the child and mother will be cared for by our pediatric nurses and medical team in the infant ward during this time. In the first few days after the operation, your child will not be fed by mouth or via a feeding tube, but intravenously via a drip. The feeding tube will be left in the child's stomach for a few days after the operation. This is necessary in order to drain the secretions (saliva, gastric juice, small intestinal secretions) that cannot yet pass easily through the small intestine due to temporary swelling of the small intestine and the general sluggishness of the small intestine after the abdominal operation.

A few days after the operation, your child can be fed by mouth. However, it is not possible to predict how long it will take for the bowel to function normally. Every child takes its own time. If your child drinks the food completely and continues to gain weight, he or she is healthy and can be discharged home.

A follow-up appointment with us is only scheduled after a few weeks. As we only use stitches that dissolve by themselves, the first post-operative check-ups after discharge will be carried out by your pediatrician. Here you should pay particular attention to the child's drinking behavior and sufficient weight gain. However, if any questions remain unanswered or if we consider an earlier follow-up examination to be appropriate in individual cases, you can come back to us at any time.

Children with duodenal atresia have to stay in hospital for about 7-10 days after the operation. During this time, the child and mother are cared for by our pediatric nurses and medical team on the infant ward. In the first few days after the operation, your child will not be fed by mouth or via a feeding tube, but intravenously via a drip. The feeding tube will be left in the child's stomach for a few days after the operation. This is necessary in order to drain the secretions (saliva, gastric juice, small intestinal secretions) that cannot yet pass easily through the small intestine due to temporary swelling of the duodenum and the general sluggishness of the small intestine after the abdominal operation.

A few days after the operation, your child can be fed by mouth. However, it is not possible to predict how long it will take for the bowel to function normally. Every child takes its own time. If your child drinks the food completely and continues to gain weight, he or she is healthy and can be discharged home.