# Isoperistaltic hand-sewn side-to-side bowel primary anastomosis: a safe approach after bowel resection in children with neutropenic enterocolitis

## TL;DR

This study shows that using a specific type of hand-sewn bowel connection after surgery for a serious gut condition in children with cancer is safer than other methods.

## Contribution

The study introduces the isoperistaltic hand-sewn side-to-side anastomosis as a safer alternative in pediatric cancer patients with neutropenic enterocolitis.

## Key findings

- 85% of primary anastomosis cases used the ISSA technique with a 8.8% leakage rate.
- Stoma patients had a higher complication rate (52.1%) compared to those with primary anastomosis (43.8%).
- EEA and ESA had significantly higher leakage rates than ISSA.

## Abstract

Whether to perform primary anastomosis (PA) or create a stoma after bowel resection has always been a dilemma in pediatric cancer patients with neutropenic enterocolitis (NEC). The risk of leakage after PA must be weighed against the risk of stoma complications. We evaluated the outcomes of managing NEC patients with either PA or stoma and the utility of the isoperistaltic hand-sewn side-to-side anastomosis (ISSA) technique in PA.

A retrospective study on all Children's Cancer Hospital Egypt patients with NEC who underwent surgical exploration at our hospital from 2008 to 2022.

Of 153 children, 80 (52.3%) underwent PA and 73 (47.7%) underwent stoma formation. Among the 80 PA patients, 68 (85%) underwent ISSA, 9 (11.2%) end-to-end anastomosis (EEA), and 3 (3.8%) end-to-side anastomosis (ESA). The perioperative complication rate was 38/73 (52.1%) in the stoma patients and 35/80 (43.8%) in the PA patients. Leakage occurred in 6/68 (8.8%) ISSA patients, 5/9 (55.6%) EEA patients, and 1/3 (33.3%) of ESA patients.

In pediatric cancer patients with NEC, PA using ISSA after bowel resection is considered a better approach than any other anastomotic configuration.