# Small Intestinal Atresia: Should We Preserve the Peel or Toss It?

## TL;DR

This study compares surgical approaches for apple-peel atresia in infants and finds that preserving the atretic segment may be as effective as resection.

## Contribution

The study provides novel long-term outcome data comparing resection versus preservation of apple-peel atresia in neonates.

## Key findings

- Overall survival at discharge was 87.5% in both surgical approaches.
- Preserving the atretic segment did not lead to worse outcomes despite longer hospital stays.
- Reoperations were needed in 4 children due to complications like anastomotic obstruction.

## Abstract

Background: Apple peel atresia (APA) is a rare and severe form of intestinal atresia, but little is known on long-term outcomes. We compared outcomes of apple-peel atresia based on different surgical approaches. Methods: a retrospective review from two institutions compared APA-resected and APA-preserved patients. Demographics, operative details, postoperative courses and long-term outcomes were analyzed. Results: Of the 16 APA neonates, 10 (62.5%) were in APA-resected and 6 (37.5%) in APA-preserved groups. Early postoperative complications occurred in 7 patients (43.75%) including vomiting, infection, intestinal occlusion, anastomotic dehiscence, multiorgan failure, equally distributed among groups. Length-of-stay is higher in the APA-preserved group (median 67 vs. 27 days, p = 0.14). Overall survival at discharge was 87.5%. Twelve children (75%) were followed for an average of 5 years. Reoperation was required in 4 children owing to anastomotic obstruction and adhesive intestinal obstruction, two in each group. Conclusion: to prevent intestinal failure, keeping the APA shows not inferior results compared to resection, even though it may have a longer first-postoperative course.