Management of Proximal Jejunal Atresia by Enterostomy with a Modified T-tube: A Comparative Clinical Study

A BSTRACT Background: Neonatal proximal jejunal atresia continues to present significant postoperative morbidity due to proximal dilatation, poor motility, and difficulty in early feeding. Traditional T-tube enterostomy has been used to provide decompression and stenting. We adopted a modified technique using two infant feeding tubes configured to function as proximal decompression and distal feeding limbs. Objective: To evaluate and compare the clinical outcomes of an enterostomy with a modified T-tube versus primary anastomosis in neonates with proximal jejunal atresia. Materials and Methods: This ambispective comparative study included 40 neonates. Group A ( n = 20) underwent primary anastomosis (retrospective cohort), while Group B ( n = 20) received an enterostomy with a modified T-tube (prospective cohort). Outcomes assessed included time to start oral feeds, anastomotic leak rate, hospital stay, and mortality. Statistical analysis was conducted using the unpaired t -test and Fisher’s exact test. Results: The modified T-tube group showed significantly earlier initiation of oral feeding (7.08 ± 2.30 days vs. 10.57 ± 3.78 days, P = 0.004), fewer anastomotic leaks (15% vs. 55%, P = 0.013), and improved survival (65% vs. 35%, P = 0.047) compared to the primary anastomosis group. No significant difference was observed in hospital stay between the groups ( P = 0.70). Conclusion: An enterostomy with a modified T-tube significantly improves clinical outcomes in neonatal proximal jejunal atresia. It reduces anastomotic leaks, facilitates earlier feeding, and enhances survival. Given its simplicity, safety, and measurable benefits, it should be considered a preferred approach in appropriately selected cases.