Duodenal Atresia: Open versus MIS Repair—Analysis of Our Experience over the Last 12 Years

Abstract

Objective. Duodenal atresia (DA) routinely has been corrected by laparotomy and duodenoduodenostomy with excellent long-term results. We revisited the patients with DA treated in the last 12 years (2004–2016) comparing the open and the minimally invasive surgical (MIS) approach. Methods. We divided our cohort of patients into two groups. Group 1 included 10 patients with CDO (2004–09) treated with open procedure: 5, DA; 3, duodenal web; 2, extrinsic obstruction. Three presented with Down's syndrome while 3 presented with concomitant malformations. Group 2 included 8 patients (2009–16): 1, web; 5, DA; 2, extrinsic obstruction. Seven were treated by MIS; 1 was treated by Endoscopy. Three presented with Down's syndrome; 3 presented with concomitant malformations. Results. Average operating time was 120 minutes in Group 1 and 190 minutes in Group 2. In MIS Group the visualization was excellent. We recorded no intraoperative complications, conversions, or anastomotic leakage. Feedings started on 3–7 postoperative days. Follow-up showed no evidence of stricture or obstruction. In Group 1 feedings started within 10–22 days and we have 1 postoperative obstruction. Conclusions. Laparoscopic repair of DA is one of the most challenging procedures among pediatric laparoscopic procedures. These patients had a shorter length of hospitalization and more rapid advancement to full feeding compared to patients undergoing the open approach. Laparoscopic repair of DA could be the preferred technique, safe, and efficacious, in the hands of experienced surgeons.

Congenital duodenal obstruction: Ten-year results of a tertiary center

“…The most common extrinsic cause was found to be annulo-pancreas and the most common intrinsic cause was reported as atresia (11). Ladd's bands from extrinsic causes are mostly resected; diamond-shaped duodenoduodenostomy method is commonly used which is described in 1990 by Kimura in the treatment of all intrinsic conditions like atresia, web, stenosis and some extrinsic causes such as the annular pancreas and superior mesenteric artery pressure (3,12). Depending on the location of the obstruction, duodenojejunostomy is another preferred method (6).…”

“…Duodenal obstructions have been reported to be associated with other congenital anomalies with a probability of 38-55% (13) The most common additional anomaly is Down Syndrome (8). Other anomalies are anorectal malformations, esophageal atresia, cardiac defects, urinary and extremity anomalies (3)(4)(5)(6). However, these anomalies have no effect on survival (8).…”

“…In the 1931, the first operation of CDO was performed by Ladd. In that time mortality rate was reported about 40% but it has been reduced to 5% in recent years due to improvements in neonatal intensive care and pediatric anesthesia (3). Published studies on duodenal obstruction are limited in Turkey.…”

Development and Preliminary Validation of a Rabbit Model of Duodenal Atresia for Training in Pediatric Surgical Skills

“…A suitable method for repair of this type of defect has been using a laparoscopic approach. 1 Nonetheless, laparoscopic duodenal atresia repair shows a high degree of complexity and difficulty for pediatric surgeons with little experience, where the only means of learning technical skills is often directly in the patient. 2…”

Exploring the neglected segment of the intestine: the duodenum and its pathologies

“…Duodenal atresia shows a typical 'double bubble' sign and the absence of small and large bowel gas on plain radiograph ( Figure 1). It is usually post ampullary in 85% of cases [3], and patients present with bilious vomiting within two days of birth. Duodenal web is a type 1 duodenal atresia in which a thin diaphragm-like membrane forms in the duodenal lumen secondary to defective recanalisation.…”