Lessons learned from a retrospective analysis of Intestinal atresia management: Implications for future practice

Aims: Pediatric intestinal atresia poses a significant challenge for pediatric surgeons, especially in our area, where it is often treated as an emergency. Numerous factors affect patient outcomes, making it essential to identify potential management pitfalls. This study seeks to assess the management and outcomes of neonatal intestinal atresia in our Institution, pinpointing challenges, pitfalls, and areas for enhancement to improve patient care and outcomes. Methods: This is a retrospective observational study conducted at a tertiary care pediatric surgical center in Eastern India. The study spans five years, from January 2020 to June 2025, and includes all neonates and children who underwent surgery for intestinal atresia during this time. Results: A total of 31 patients with intestinal atresia were included in this retrospective study conducted over five years. Most patients (87%) were in the neonatal age group, with only 13% presenting in the post-neonatal period. There was a male predominance, with 24 males (77.4%) and 7 females (22.6%). Two primary anatomical categories were identified: Jejunoileal atresia (JIA) was the predominant condition, observed in 24 patients (77.4%). Duodenal web or duodenal atresia was present in 7 patients (22.6%). Among the JIA cases, type 3a was the most prevalent, accounting for 22.6%. The average duration to start enteral feeding was 16 days. The mean total duration until discharge was 21.7 days. The overall mortality rate was 38.7%, with 12 out of 31 patients succumbing. Conclusion: Children with gastrointestinal atresia often present late in their illness, experiencing significant morbidity and mortality due to factors such as poor economic conditions, inadequate nutrition, surgical challenges, and potentially related anomalies, rather than solely surgical morbidity. The high mortality rate observed in our study indicates a need to enhance our management protocols, which may be linked to delayed presentation, insufficient preoperative care, or postoperative complications. Further research is necessary to pinpoint specific areas for improvement and optimise patient outcomes.