{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:54:18Z","timestamp":1760057658991,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/children12020240","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T10:26:12Z","timestamp":1739787972000},"page":"240","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Small Intestinal Atresia: Should We Preserve the Peel or Toss It?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3487-1910","authenticated-orcid":false,"given":"Benedetta","family":"Marino","sequence":"first","affiliation":[{"name":"UOC Pediatric Surgery, Department of Women\u2019s and Children\u2019s Health, University of Padua, 35128, Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Mottadelli","sequence":"additional","affiliation":[{"name":"UOC Pediatric Surgery, Ospedale Infantile \u201cCesare Arrigo\u201d, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Bisol","sequence":"additional","affiliation":[{"name":"UOC Pediatric Surgery, Department of Women\u2019s and Children\u2019s Health, University of Padua, 35128, Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Sergio","sequence":"additional","affiliation":[{"name":"UOC Pediatric Surgery, Azienda Ospedaliera Universitaria \u201cPaolo Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piergiorgio","family":"Gamba","sequence":"additional","affiliation":[{"name":"UOC Pediatric Surgery, Department of Women\u2019s and Children\u2019s Health, University of Padua, 35128, Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9610-1708","authenticated-orcid":false,"given":"Elisa","family":"Zambaiti","sequence":"additional","affiliation":[{"name":"UOC Pediatric Surgery, Department of Women\u2019s and Children\u2019s Health, University of Padua, 35128, Padua, Italy"},{"name":"UOC Pediatric Surgery, Ospedale Infantile Regina Margherita, 10126 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"ref_1","unstructured":"Coran, A.G., Adzik, N.S., Krummel, T.M., Laberge, J.M., Caldamone, A., and Shamberger, R. (2012). Paediatric Surgery, Elsevier\u2019s Saunders. [7th ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"F353","DOI":"10.1136\/fetalneonatal-2011-300631","article-title":"Epidemiology of small intestinal atresia in Europe: A register-based study","volume":"97","author":"Best","year":"2012","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Gao, Y., Ru, Y., Han, H., Yin, H., Yin, P., and Gao, Y. (2023). Prenatal Ultrasound Diagnosis and Clinical Analysis of Fetal Small Bowel Obstruction. Curr. Med. Imaging, 19.","DOI":"10.2174\/0115734056262425231031171130"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.jpedsurg.2007.09.053","article-title":"Intestinal atresias: Factors affecting clinical outcomes","volume":"43","author":"Piper","year":"2008","journal-title":"J. Pediatr. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s00383-019-04594-y","article-title":"Jejuno-ileal atresia: Its characteristics and peculiarities concerning apple peel atresia, focused on its treatment and outcomes as experienced in one of the leading South African academic centres","volume":"36","author":"Mangray","year":"2020","journal-title":"Pediatr. Surg. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jpedsurg.2008.10.043","article-title":"Decreased mortality but increased morbidity in neonates with jejunoileal atresia; A study of 114 cases over a 34-year period","volume":"44","author":"Stollman","year":"2009","journal-title":"J. Pediatr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1007\/s00383-009-2422-y","article-title":"Prognostic factors in jejuno-ileal atresia","volume":"25","author":"Burjonrappa","year":"2009","journal-title":"Pediatr. Surg. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1016\/j.jpedsurg.2014.06.010","article-title":"Prolonged feeding difficulties after surgical correction of intestinal atresia: A 13-year experience","volume":"49","author":"Wang","year":"2014","journal-title":"J. Pediatr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.gtc.2019.08.004","article-title":"Predictors of Intestinal Adaptation in Children","volume":"48","author":"Venick","year":"2019","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1093\/gastro\/goz026","article-title":"Comparison of outcomes following three surgical techniques for patients with severe jejunoileal atresia","volume":"7","author":"Peng","year":"2019","journal-title":"Gastroenterol. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1055\/s-2002-32726","article-title":"Trends in the management and outcome of jejuno-ileal atresia","volume":"12","author":"Kumaran","year":"2002","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: Five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s003830100019","article-title":"Intestinal atresia: An end-to-end linear anastomotic technique","volume":"17","author":"Patil","year":"2001","journal-title":"Pediatr. Surg. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1016\/j.jpedsurg.2013.04.024","article-title":"Apple-peel intestinal atresia: Enteroplasty for intestinal lengthening and primary anastomosis","volume":"48","author":"Onofre","year":"2013","journal-title":"J. Pediatr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3642","DOI":"10.1016\/j.asjsur.2023.01.028","article-title":"Antimesenteric sleeve tapering enteroplasty with end-to-end anastomosis versus primary end-to-side anastomosis for the management of jejunal\/ileal atresia","volume":"46","author":"Kurdi","year":"2023","journal-title":"Asian J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"107095","DOI":"10.1016\/j.ijscr.2022.107095","article-title":"Complex gastroschisis with apple peel jejunoileal atresia, primary closure, and Santulli procedure as a surgical alternative. Case report","volume":"94","year":"2022","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Rashwan, H., and Kotb, M. (2022). T-tube enterostomy in the management of apple-peel atresia: A case series from a single center. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.1003508"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1089\/lap.2021.0395","article-title":"Laparoscopic Management of Congenital Intestinal Obstruction: Duodenal Atresia and Small Bowel Atresia","volume":"31","author":"Guelfand","year":"2021","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.bpg.2016.02.011","article-title":"Definitions of intestinal failure and the short bowel syndrome","volume":"30","author":"Pironi","year":"2016","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Han, J., Hao, Z., Wang, L., Yao, T., Fan, W., Zhao, Z., Huang, L., and Xu, Z. (2022). The role of preserved bowel and mesentery fixation in apple-peel intestinal atresia. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03475-z"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1053\/jpsu.2001.22958","article-title":"Jejunoileal atresia and associated malformations: Correlation with the timing of in utero insult","volume":"36","author":"Sweeney","year":"2001","journal-title":"J. Pediatr. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1053\/jpsu.2002.29428","article-title":"Excellent long-term outcome for survivors of apple peel atresia","volume":"37","author":"Festen","year":"2002","journal-title":"J. Pediatr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2503","DOI":"10.1016\/j.jpedsurg.2019.08.045","article-title":"Long-term surgical outcomes of apple-peel atresia","volume":"54","author":"Zhu","year":"2019","journal-title":"J. Pediatr. Surg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/2\/240\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:36:27Z","timestamp":1760027787000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/2\/240"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,17]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["children12020240"],"URL":"https:\/\/doi.org\/10.3390\/children12020240","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,2,17]]}}}