ECMO-/ECLS

Pre-operatively, an OG tube should be placed for decompression. Fluid losses
are replaced. Evaluation for other anomalies should be done as necessary.
Prophylactic antibiotics should be administered, but should be discontinued within 24
hours.
Surgical repair for duodenal atresias usually entail an anastomosis between the
bowel proximal and distal to the obstruction. If a web is involved, care is taken not to
harm the ampulla, since the ampulla can be involved in the web. The ampulla is usually
located in the posteromedial aspect of the web.
For jejunal and ileal atresia, resection of the dilated segment and reanastomosis
is performed. With all atresias, ruling out the presence of other atresias is mandatory.
If only a limited length of intestine is present, the surgeon would refrain from resecting
any intestine. An intestinal lengthening procedure (such as serial transverse
enteroplasty) may be done in the future to increase intestinal length.
Post-operative management of patients with intestinal atresias typically involves
awaiting intestinal function to resume and supporting the patient during this time.
Ventilatory support is provided, if needed. Fluid losses from the stomach should be
monitored and replaced as necessary. The baby is given parenteral nutrition until ileus
resolves as evidenced by stool output and decreasing output from the OG tube. Foregut
dysmotility takes at least 2-3 weeks’ time to resolve in duodenal atresia. Some centers
start early trophic feeds in children with duodenal atresia after a contrast study
documents no leakage through a patent anastomosis.