Duodenal Atresia: A Comparison of Three Modes of Treatment

Upadhyay, Vipul; Sakalkale, R; Parashar, Kalind; Mitra, S.; Buick, R.G.; Gornall, P.; Corkery, J.J.

doi:10.1055/s-2008-1066475

Cited by 23 publications

(16 citation statements)

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“…Arnbjörnsson [11] studied retrospectively 18 consecutives newborns with duodenal atresia, 9 from each of two different centres of pediatric surgery; Upadhyay [12] described 33 consecutives cases of duodenoduodenostomy (diamond-shaped anastomosis in 9 cases). Kimura's DSD reduced drastically the time of postoperative canalisation and achieved better results than previous types of duodenoduodenostomy .…”

Section: Discussionmentioning

confidence: 99%

The Modified Kimura's Technique for the Treatment of Duodenal Atresia

Zuccarello

Spada

Centorrino

et al. 2009

International Journal of Pediatrics

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Background/Purpose. Kimura's diamond-shaped-duodenoduodenostomy (DSD) is a known technique for the correction of congenital intrinsic duodenal obstruction. We present a modification of the technique and review the advantages of this new technique. Methods. From 1992 to 2006, 14 newborns were treated for duodenal atresia. We inverted the direction of the duodenal incisions: a longitudinal incision was made in the proximal duodenum while the distal was opened by transverse incision. Results. Our “inverted-diamond-shaped-duodenoduodenostomy” (i-DSD) allowed postoperative oral feeding to start on days 2 to 3, peripheral intravenous fluids discontinuity on days 3 to 8 (median values 3.6); time to achieve full oral feeds on days 8 to 12 (median values 9.4); the length of hospitalisation ranged from 10 and 14 days (median value 11.2). No complications related to the anastomosis, by Viz leakage, dehiscence, biliary stasis, or stenosis were observed. Conclusions. The i-DSD provides a safe procedure to protect the ampulla of Vater from injury and avoids any formation of a blind loop. The results show that patients who have i-DSD achieve full oral feeds in a very short time period and, consequently, the length of hospitalisation is also significantly reduced.

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Section: Discussionmentioning

confidence: 99%

The Modified Kimura's Technique for the Treatment of Duodenal Atresia

Zuccarello

Spada

Centorrino

et al. 2009

International Journal of Pediatrics

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“…A prenatal diagnosis was made in 57% of recently managed cases compared with less than 20% in other series 4,5 . Moreover, there has been a trend towards avoiding the use of transanastomotic feeding tubes which have been shown to increase time to full oral feeding 6,12 .…”

Section: Discussionmentioning

confidence: 99%

Intrinsic duodenal obstruction: trends in management and outcome over 45 years (1951–1995) with relevance to prenatal counselling

Murshed¹,

Nicholls²,

Spitz³

1999

BJOG

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Objective To investigate the incidence of associated anomalies and document changes and progress in the management and outcome of intrinsic duodenal obstruction (atresia or stenosis) in a large series over a long time period with a view to providing comprehensive data for prenatal counselling.Design A retrospective casenote review.Setting A quaternary referral centre for paediatxic and neonatal surgery.Population l b o hundred and seventy-five infants born with duodenal obstruction between 1951 and 1995.Methods For analysis of management and outcome data, the series was divided into three groups, each admitted over 15 yearperiods: Group A, 1951-1965 Group B, 1966 Group B, -1980; Group C, 1981-1995. Main outcome measures Primary: associated anomalies, complication rates and survival. Secondary: age at diagnosis, duration of hospital stay.Results There were 136 males and 139 females. Seventeen of 30 cases (57%) presenting between 1991 and 1995 were diagnosed prenatally on ultrasound scan. The median age at diagnosis for atresia was 3-5 days (Group A); 2.2 days (Group B) and 1.8 days (Group C). The median age at diagnosis for incomplete obstruction was five days. Associated anomalies included Down's syndrome (n = 82, 30%); Down's plus cardiac malformation (n = 38, 14%); isolated cardiac (n = 64,23%); and gastrointestinal problems (n = 116,42%). Overall complication rates fell from 51% (Group A) to 18% (Group C ) and survival increased from 5 1 % to 95% . Median hospital stay also decreased from 35 days to 18 days.Conclusions These data c o n f m a progressive improvement in the outcome of intrinsic duodenal obstruction over the past 45 years. It is important to note that they only relate to infants born with duodenal atresia and do not take into account possible 'hidden' mortality resulting from spontaneous abortion or termination.

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“…7 The duodenal obstruction is a relative emergency, and the patient should not be rushed to the operating room until hemodynamic status and fluid and electrolyte status are normalized. 8 The abdomen is entered best through a transverse right upper quadrant incision, a standard side-to-side or, preferably, proximal transverse-to-distal longitudinal (diamond-shaped) anastomosis may be performed using fine interrupted suture. 9 If the proximal duodenum is excessively floppy and distended, an ant mesenteric tapering duodenoplasty or plication may be useful.…”

Section: Discussionmentioning

confidence: 99%