Paediatric surgery.Ukraine.2020.2(67):14-21; doi 10.15574/PS.2020.67.14
Sliepov O. K., Migur M. Y., Ponomarenko O. P., Gladyshko O. P., Markevich O. V., Grebinichenko G. О.
Center of Neonatal Surgery of Congenital Malformations and its Rehabilitation SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova NAMS of Ukraine», Kyiv

For citation: Sliepov OK, Migur MY, Ponomarenko OP, Gladyshko OP et al. (2020). The first experience of lengthening enteroplasty for short bowel syndrome in a one-month-old baby in Ukraine. Paediatric Surgery.Ukraine. 2(67):14-21. doi 10.15574/PS.2020.67.14
Article received: Feb 27, 2020. Accepted for publication: Jun 13, 2020.

Closed gastroschisis is one of the rarest forms of gastroschisis, in which the prolapsed organs are pinched in a stenotic defect of the anterior abdominal wall. This leads to the development of local or total compression infarction of the eventrated midgut and the development of short bowel syndrome. Surgical treatment of this pathology is complex and multi-stage, and presents great difficulties for pediatric surgeons around the world.
Case report. Assumption of closed gastroschisis is established prenatally. 10 minutes after the birth, an operation was performed: mobilization and reduction of eventrated organs with primary fascial abdominoplasty. At the same time, no reliable signs of intestinal obstruction were found. On the 5th day of life, Mikulicz enterostomy was performed for the diagnosed atresia of the jejunum. On the 32nd day of life, the final stage of surgical management was performed: relaparotomy, adhesiolysis, enterostomy, narrowing and lengthening of the jejunum with serial transverse enteroplasty procedure. At the age of 1.5 months, the child achieved complete enteral autonomy.
The proposed tactics and strategy of surgical treatment is effective, made it possible to lengthen the small intestine and maintain the absorption surface of the mucosa in order to achieve full enteral autonomy.
Level of evidence – V.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution.The informed consent of the child’s parents was obtained from the studies.
No conflict of interest was declared by the authors.
Key words: vanishing gastroschisis, intestinal atresia, intestinal lengthening, short bowel syndrome, serial transverse enteroplasty procedure.

REFERENCES

1. Andrade WS, Brizot ML, Francisco RPV et al. (2019, Sep). Fetal intra-abdominal bowel dilation in prediction of complex gastroschisis. Ultrasound Obstet Gynecol. 54 (3): 376–380. https://doi.org/10.1002/uog.20367; PMid:31264279. Epub 2019 Aug 8.

2. Feng C, Graham CD, Connors JP et al. (2016, Jan). Transamniotic stem cell therapy (TRASCET) mitigates bowel damage in a model of gastroschisis. J Pediatr Surg. 51 (1): 56–61. https://doi.org/10.1016/j.jpedsurg.2015.10.011; PMid:26548631

3. Hass HJ, Krause H, Herrmann K, Gerloff C, Meyer F. (2009, Dec). Colon triplication associated with ileum atresia in laparoschisis. Zentralbl Chir. 134 (6): 550–552. https://doi.org/10.1055/s-0028-1098762; PMid:19708012

4. Hukkinen M, Kivisaari R, Koivusalo A et al. (2017). Risk factors and outcomes of tapering surgery for small intestinal dilatation in pediatric short bowel syndrome. J. Pediatr. Surg. 52 (7): 1121–1127. https://doi.org/10.1016/j.jpedsurg.2017.01.052; PMid:28185632

5. Jorge Correia–Pinto, Marta L. Tavares, Maria J. Baptista et al. (2006, May). Meconium dependence of bowel damage in gastroschisis. 41 (5): 897–900.

6. Kim HB, Fauza D, Garza J, Oh JT, Nurko S, Jaksic T. (2003, Mar). Serial transverse enteroplasty (STEP): a novel bowel lengthening procedure. J Pediatr Surg. 38 (3): 425–429. https://doi.org/10.1053/jpsu.2003.50073; PMid:12632361

7. Kimble RM, Blakelock R, Cass D. (1999). Vanishing gut in infants with gastroschisis. Pediatr Surg Int. 15 (7): 483–485. https://doi.org/10.1007/s003830050644; PMid:10525904

8. Kronfli R, Bradnock TJ, Sabharwal A. (2010, Sep). Intestinal atresia in association with gastroschisis: a 26-year review. Pediatr Surg Int. 26 (9): 891–894. https://doi.org/10.1007/s00383-010-2676-4; PMid:20676892

9. Kumar T, Vaughan R, Polak M. (2013 Feb). A proposed classification for the spectrum of vanishing gastroschisis. Eur J Pediatr Surg. 23 (1): 72–75. https://doi.org/10.1055/s-0032-1330841; PMid:23172564. Epub 2012 Nov 21.

10. Molik KA, Gingalewski CA, West KW, Rescorla FJ, Scherer LR, Engum SA et al. (2001). Gastroschisis: a plea for risk categorization. J Pediatr Surg. 36: 51–55. https://doi.org/10.1053/jpsu.2001.20004; PMid:11150437

11. Ogunyemi D. (2001). Gastroschisis Complicated by Midgut Atresia, Absorption of Bowel, and Closure of the Abdominal Wall Defect. Fetal Diagn Ther. 16: 227–230. https://doi.org/10.1159/000053915; PMid:11399884

12. Sinkey RG, Habli MA, South AP et al. (2016, Feb). Sonographic markers associated with adverse neonatal outcomes among fetuses with gastroschisis: an 11-year, single-center review. Am J Obstet Gynecol. 214 (2): 275. e1-275.e7. https://doi.org/10.1016/j.ajog.2015.09.081; PMid:26454131. Epub 2015 Oct 8.

13. Sliepov OK, Migur MY, Soroka VP, Ponomarenko O.P (2019). Surgical management of complicated gastroschisis. А single centre experience. Paediatric surgery. Ukraine. 4 (65): 35–42. https://doi.org/10.15574/PS.2019.65.35.

14. Sliepov OK, Migur MYu, Ponomarenko OP, Tabachnikova EYu. (2018). Influence of the Eviscerated Bowel Status on Digestive Tract Motility Recovery After Surgery for Gastrochisis in Neonates. Paediatric surgery. Ukraine. 1 (58): 75–80. https://doi.org/10.15574/PS.2018.58.75.

15. Sliepov OК, Migur MY, Ponomarenko OP et al. (2018). Longitudinal enteroplasty as a method of primary treatment in newborns with proximal jejunal atresia. Paediatric Surgery Ukraine. 4 (61): 87–92. https://doi.org/10.15574/PS.2018.61.87.

16. Snyder CL, Miller KA, Sharp RJ, Murphy JP, Andrews WA, Holcomb GW 3rd, Gittes GK, Ashcraft KW. (2001, Oct). Management of intestinal atresia in patients with gastroschisis. J Pediatr Surg. 36 (10): 1542–1545. https://doi.org/10.1053/jpsu.2001.27040; PMid:11584405

17. Takahashi A, Tomomasa T, Suzuki N et al. (1997). The relationship between disturbed transit and dilated bowel, and manometric findings of dilated bowel in patients with duodenal atresia and stenosis. J. Pediatr. Surg. 32: 1157–1160. https://doi.org/10.1016/S0022-3468(97)90674-6

18. Wales PW, Dutta S. (2005, Mar). Serial transverse enteroplasty as primary therapy for neonates with proximal jejunal atresia. J Pediatr Surg. 40 (3): E31–34. https://doi.org/10.1016/j.jpedsurg.2004.11.005; PMid:15793710

19. Wood SJ, Samangaya RA, Gillham JC, Morabito A. (2014). Gastroschisis and the risk of short bowel syndrome: outcomes and counselling. Neonatology. 105 (1): 5–8. https://doi.org/10.1159/000351038; PMid:24193105. Epub 2013 Oct 31.

20. Zachary Bauman, Victor Nanagas Jr. (2015). The Combination of Gastroschisis, Jejunal Atresia, and Colonic Atresia in a Newborn. Case Reports in Pediatrics. 2015. Article ID 129098: 4. https://doi.org/10.1155/2015/129098; PMid:26180651 PMCid:PMC4477220