Primary anastomosis in jejunoileal atresia: A qualitative synthesis of outcomes, surgical techniques, and decision-making factors

Jejunoileal atresia (JIA) is a frequent cause of neonatal intestinal obstruction requiring prompt surgical correction. While enterostomy has traditionally been used in complex or unstable cases, primary anastomosis (PA) is now widely regarded as the preferred surgical approach for JIA, owing to advances in neonatal care and surgical technique. This review aimed to synthesize current evidence on the safety, efficacy, and clinical outcomes of PA in neonates with JIA. This study conducted through a systematic search of PubMed, EMBASE, Web of Science, and Scopus included studies from 2010 to 2025. Nine observational cohort studies involving over 600 neonates were included. Outcomes assessed included surgical complications, mortality, reoperation, nutritional recovery, and hospital stay. Study quality was evaluated using the Newcastle–Ottawa Scale. Primary anastomosis was performed in up to 78 % of neonates and was associated with shorter time to full enteral feeding (median 17–22 days vs. up to 60 days in enterostomy), fewer general anesthetics, and reduced stoma-related complications. Despite a reoperation rate of 22–38 %, mostly due to dysmotility or obstruction, PA was associated with lower rates of mortality and major complication. Modified techniques like tapering enteroplasty improved feasibility in anatomically challenging cases. In contrast, Bishop–Koop procedures showed lower reoperation rates but were mostly reserved for high-risk patients. Primary anastomosis appears to be a safe and effective option for many neonates with JIA based on the available evidence, provided you are supported with postoperative effective neonatal care. Careful patient selection and surgical adaptation remain key to optimizing outcomes. Further high-quality studies are needed to strengthen these findings.