الفهرس 
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Abstract
The incidence of jejuno-ileal atresia is about 1:5000 live births. In cases of small bowel atresia, dilated bowel segment usually involves large portion of proximal intestine, so at what ever point resection is performed, the discrepancy in diameter between proximal and distal segment does not change; thus performing anastomosis is a difficult task.
The key for successful treatment of neonates with intestinal atresia is comprehensive peri-operative care. This is usually best accomplished by a team that includes experienced surgeons, neonatologists, and nutritional support teams. Early diagnosis, proper preoperative stabilization, the right choice of surgical procedure, and good postoperative neonatal care are the most important considerations. Neonates tolerate surgical procedures best when they are metabolically and hemodynamically stable.
Multiple theories regarding the etiology of jejuno-ileal atresias have been studied in many animal models. To date, the most accepted theory regarding the etiology of jejuno-ileal atresia is that of an intrauterine vascular accident resulting in necrosis of the affected segment, with subsequent resorption.
Clinically neonates with a proximal atresia develop bilious emesis within hours, whereas patients with more distal lesions may take longer to begin vomiting. A normal or scaphoidlike abdomen in a neonate with bilious emesis should be considered indicative of a proximal obstruction until proven otherwise. Abdominal distension is more pronounced with distal lesions. Radiography is helpful to confirm the diagnosis. Although a plain radiograph can depict the presence of an obstruction, it is not the best method of showing the location of the abnormality, An upper GI with small-bowel follow-through is indicated in these patients, A barium enema may be used to define a micro colon indicative of a distal small-bowel obstruction; it is also capable of establishing the diagnosis of other causes of lower obstruction, such as Hirschsprung disease or a meconium plug. The contrast enema may also reflux into the small bowel and help define the level of a distal obstruction.
This study included 40 patients with jejenoileal atresias, 25 patients underwent resection of the atretic part and the dilated proximal segment followed by end to end anastomosis, and 15 patients underwent tapering of the proximal dilated segment followed by end to end anastomosis.
The aim of this study is to compare outcomes of resection with end to end anastomosis in comparison with end to end anastomosis after enteroplasty in cases of jejuno-ileal atresia.
Operative time in resection group was 1:20 – 1:50 hour, mean operative time was 92.72 where in tapering group it was 1:40 – 2:30 hour, mean operative time was 127.86 with P value <0.0001, which is a highly significant statistical difference, Blood transfusion was needed in 6 cases of resection group and needed in 10 cases of tapering group with P value 0.008, which is a significant statistical difference.
Functional problems occurred in 20%of cases in the form of vomiting in 15 % of cases and diarrhea in 5%of cases, post operative leakage occurred in10% of cases 5% in resection group and 5% in tapering group , P value was 0.59. Mortality occurred in 10% of cases, 5% of cases in resection group and 5% of cases in tapering group with P value 0.59.
IN conclusion:
Tapering enteroplasty is a valuable option in treatment of jejenoileal atresia especially in proximal types where resection of the proximal dilated segment is difficult task or when the length of the bowel is decreased, to avoid postoperative functional complications
Statistically it is more time consuming and has increased incidence of blood loss however there is no statistically different incidence of morbidity or mortality between the resection of dilated segment and end to end anastomosis, and end to end anastomosis after tapering enteroplasty procedures.