Eeftinck Schattenkerk Laurens D, Musters Gijsbert D, Nijssen David J, de Jonge Wouter J, de Vries Ralph, van Heurn L W Ernest, Derikx Joep P M
Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Innov Surg Sci. 2021 Aug 17;6(4):127-150. doi: 10.1515/iss-2020-0042. eCollection 2021 Dec 1.
Ileus following surgery can arise in different forms namely as paralytic ileus, adhesive small bowel obstruction or as anastomotic stenosis. The incidences of these different forms of ileus are not well known after abdominal birth defect surgery in infants. Therefore, this review aims to estimate the incidence in general between abdominal birth defects.
Studies reporting on paralytic ileus, adhesive small bowel obstruction or anastomotic stenosis were considered eligible. PubMed and Embase were searched and risk of bias was assessed. Primary outcome was the incidence of complications. A meta-analysis was performed to pool the reported incidences in total and per birth defect separately.
This study represents a total of 11,617 patients described in 152 studies of which 86 (56%) had a follow-up of at least half a year. Pooled proportions were calculated as follows; paralytic ileus: 0.07 (95%-CI, 0.05-0.11; =71%, p≤0.01) ranging from 0.14 (95% CI: 0.08-0.23) in gastroschisis to 0.05 (95%-CI: 0.02-0.13) in omphalocele. Adhesive small bowel obstruction: 0.06 (95%-CI: 0.05-0.07; =74%, p≤0.01) ranging from 0.11 (95% CI: 0.06-0.19) in malrotation to 0.03 (95% CI: 0.02-0.06) in anorectal malformations. Anastomotic stenosis after a month 0.04 (95%-CI: 0.03-0.06; =59%, p=0.30) ranging from 0.08 (95% CI: 0.04-0.14) in gastroschisis to 0.02 (95% CI: 0.01-0.04) in duodenal obstruction. Anastomotic stenosis within a month 0.03 (95%-CI 0.01-0.10; =81%, p=0.02) was reviewed without separate analysis per birth defect.
This review is the first to aggregate the known literature in order approximate the incidence of different forms of ileus for different abdominal birth defects. We showed these complications are common and the distribution varies between birth defects. Knowing which birth defects are most at risk can aid clinicians in taking prompt action, such as nasogastric tube placement, when an ileus is suspected. Future research should focus on the identification of risk factors and preventative measures. The incidences provided by this review can be used in those studies as a starting point for sample size calculations.
术后肠梗阻可表现为不同形式，即麻痹性肠梗阻、粘连性小肠梗阻或吻合口狭窄。婴儿腹部出生缺陷手术后这些不同形式肠梗阻的发生率尚不清楚。因此，本综述旨在总体评估腹部出生缺陷之间的发生率。
报告麻痹性肠梗阻、粘连性小肠梗阻或吻合口狭窄的研究被视为符合要求。检索了PubMed和Embase，并评估了偏倚风险。主要结局是并发症的发生率。进行了荟萃分析，分别汇总了报告的总体发生率和每种出生缺陷的发生率。
本研究共纳入了152项研究中描述的11617例患者，其中86项（56%）的随访时间至少为半年。汇总比例计算如下：麻痹性肠梗阻：0.07（95%置信区间，0.05 - 0.11；I² = 71%，p≤0.01），范围从腹裂的0.14（95%置信区间：0.08 - 0.23）到脐膨出的0.05（95%置信区间：0.02 - 0.13）。粘连性小肠梗阻：0.06（95%置信区间：0.05 - 0.07；I² = 74%，p≤0.01），范围从旋转不良的0.11（95%置信区间：0.06 - 0.19）到肛门直肠畸形的0.03（95%置信区间：0.02 - 0.06）。术后一个月吻合口狭窄：0.04（95%置信区间：0.03 - 0.06；I² = 59%，p = 0.30），范围从腹裂的0.08（95%置信区间：0.04 - 0.14）到十二指肠梗阻的0.02（95%置信区间：0.01 - 0.04）。术后一个月内吻合口狭窄：0.03（95%置信区间0.01 - 0.10；I² = 81%，p = 0.02），未按每种出生缺陷进行单独分析。
本综述首次汇总已知文献，以估算不同腹部出生缺陷的不同形式肠梗阻的发生率。我们发现这些并发症很常见，且不同出生缺陷之间的分布有所不同。了解哪些出生缺陷风险最高有助于临床医生在怀疑肠梗阻时迅速采取行动，如放置鼻胃管。未来的研究应侧重于识别风险因素和预防措施。本综述提供的发生率可用于这些研究中作为样本量计算的起点。
