[Application of Bishop-Koop stoma in refractory congenital intestinal atresia].

Objective To explore the feasibility and safety of Bishop-Koop stoma procedure in the treatment of neonates with refractory congenital intestinal atresia. Methods Clinical and follow-up data of 25 neonates with refractory congenital intestinal atresia undergoing Bishop-Koop stoma procedure in our center from January 2011 to December 2014 were retrospectively analyzed. Of 25 neonates, 13 (52% ) were male, 12 (48%) were female, the birth weight was 1600-3800 g (mean 2920 g) , the age of admission was 10 hours to 20 days, and the age of operation was 1-58 d (mean 7 d). Diameter ratio of proximal atresia intestine to distal atresia intestine was all greater than 4. Eleven cases (44%) were high jejunal atresia, 3 cases (12%) type Ⅲ b, 7 cases (28%) type Ⅳ, 14 cases (56% ) were identified as complex meconium peritonitis, and 3 cases (12% ) received reoperation. Results All the cases completed their Bishop-Koop stoma operations successfully with median operative time of 3 (1.2-4.5) hours and median intra-operative blood loss of 3.5 (1-18) ml. The postoperative complication rate was 20% (5/25) , including 3 cases of cholestasis, 1 case of ileus, and 1 case of neonatal necrotizing enterocolitis with septicemia who died 6 days after operation resulting in the mortality of 4%. Besides, 1 case gave up treatment because of economic reason. For the rest 23 neonates, the median first feeding time was 11 days and mean time was 11 (5 to 20) days; the median time of postoperative total parenteral nutrition (TPN) was 15 days and mean time was 21 (5 to 68) days; the median hospital stay was 33 days and mean hospital stay was 25 (12 to 81) days, respectively. Two-stage stoma closure operations were performed in all the 23 cases afterwards and no postoperative associated complications were found. When discharge after Bishop-Koop stoma operations, Z score of body weight was normal in 3 cases (13.0%) and lower than normal in 20 cases (87.0%) , while in hospitalization for stoma closure, Z score of body weight was normal in 19 cases (82.6%) and lower than normal in 4 cases (17.4% ). Of 23 cases, serum albumin level was normal in 9 cases (39.1% ) before operation, in 3 cases (13.0% ) when discharge and in 22 cases (95.7% ) in hospitalization for stoma closure. Conclusion Bishop-Koop stoma procedure is safe and feasible in the treatment of neonates with refractory congenital intestinal atresia, and can obviously improve the nutritional status. Key words: Bishop-Koop stoma; Intestinal anastomosis; Complex intestinal atresia; Treatment outcomes