Laparoscopic Management of Congenital Intestinal Obstruction: Duodenal Atresia and Small Bowel Atresia

Guelfand, Miguel; Harding, Constanza

doi:10.1089/lap.2021.0395

Cited by 19 publications

(12 citation statements)

References 17 publications

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“…9 As surgeon experience and technical abilities with laparoscopic duodenal repair improved, the rate of complications decreased and outcomes with open surgery were comparable to laparoscopy. 1,2,[4][5][6] This is reflected in our institution as the predominant surgical technique after 2005 was laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

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Duodenal Atresia Repair: A Single-Center Comparative Study

Cruz-Centeno

Stewart

Marlor

et al. 2023

The American Surgeon™

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Background The use of laparoscopy in the repair of duodenal atresia has been increasing. However, there is no consensus regarding which surgical approach has better outcomes. We aimed to compare the different surgical approaches and types of anastomoses for duodenal atresia repair. Methods Patients who underwent duodenal atresia repair at a single pediatric center were identified between January 2006 and June 2022. Those with concomitant gastrointestinal anomalies or who required other simultaneous operations were excluded. The primary outcome was rate of complications, defined as rate of leak, stricture, and re-operation by surgical approach and technique of anastomosis. Results A total of 78 patients were included. The majority were female (51.3%, n = 40), with a median age of 4 days (IQR 3.0,8.0) and a median weight of 2.7 kg (IQR 2.2,3.3) at repair. The re-operation rate was 7.7% (n = 6), of which two were anastomotic leaks, and four were anastomotic strictures. The leak rate was 5.6% (n = 1/18) for the open handsewn and 4.8% (n = 1/21) for the laparoscopic handsewn technique. The stricture rate was 12.5% (n = 1/8) for the laparoscopic-assisted handsewn, 9.1% (n = 2/22) for the laparoscopic U-clip, 4.8% (n = 1/21) for the laparoscopic handsewn, and none with laparoscopic stapled and laparoscopic converted to open handsewn techniques. No differences were found in complication rate when controlling for surgical approach. Conclusion The method of surgical approach did not affect the outcomes or complications in the repair of duodenal atresia.

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Section: Discussionmentioning

confidence: 99%

“…Duodenal atresia is a rare congenital anomaly characterized by a partial or complete obstruction of the duodenum occurring in approximately 1 in 5000-10,000 live births. 1,2 Surgery is the mainstay of treatment to relieve the obstruction and restore intestinal continuity.…”

Section: Introductionmentioning

confidence: 99%

Duodenal Atresia Repair: A Single-Center Comparative Study

Cruz-Centeno

Stewart

Marlor

et al. 2023

The American Surgeon™

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“…Regarding the surgical approach for SBO, the Working Group on ASBO of the World Society of Emergency Surgery recommends that laparoscopic surgery should be attempted in patients with a first episode or shorter duration of symptom onset, simple adhesion, stable hemodynamics, no abdominal distension, or peritonitis ( 11 , 25 , 31 , 45 – 47 ). A faster recovery ( 49 ) and reduced adhesive formation are the main advantages of laparoscopic exploration ( 20 , 24 , 48 , 50 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and surgical management strategy for pediatric small bowel obstruction: Experience from a single medical center

et al. 2023

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Identifying Bowel strangulation and the approach and timing of surgical intervention for pediatric SBO are still uncertain. In this study, 75 consecutive pediatric patients with surgically confirmed SBO were retrospectively reviewed. The patients were divided into group 1 (n = 48) and group 2 (n = 27) according to the presence of reversible or irreversible bowel ischemia, which was analyzed based on the degree of ischemia at the time of operation. The results demonstrated that the proportion of patients with no prior abdominopelvic surgery was higher, the serum albumin level was lower, and the proportion of patients in which ascites were detected by ultrasonography was higher in group 2 than that in group 1. The serum albumin level was negatively correlated with ultrasonographic findings of the fluid sonolucent area in group 2. There were significant differences in the choice of surgical approach between group 1 and group 2. A symptom duration of >48 h was associated with an increased bowel resection rate. The mean length of hospital stay was shorter in group 1 than that in group 2. In conclusion, immediate surgical intervention should be considered in patients with a symptom duration of >48 h or the presence of free ascites between dilated small bowel loops on ultrasonography. Laparoscopic exploration is recommended as first-line treatment in patients with stable status.

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“…Jejunoileal atresia or stenosis is a major cause of neonatal intestinal obstruction with prevalence of 1:330–1:1,500 live births. Congenital obstruction of the jejunum and ileum occurs as a result of late intrauterine vascular events, affecting the development of one or more sections of the midgut ( 4 ). MP is a type of aseptic chemical peritonitis caused by the leakage of meconium from small bowel perforations in fetuses.…”

Section: Discussionmentioning

confidence: 99%

Meconium Peritonitis, Intestinal Atresia Combined With Biliary Atresia: A Case Report

Han

Chen

et al. 2022

Front. Pediatr.

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Meconium peritonitis (MP) combined with intestinal atresia (IA) is a rare neonatal condition, and it is even rarer in combination with biliary atresia (BA). We describe a case of an infant who developed short bowel syndrome after partial intestinal resection due to MP and IA, along with a Santullienterostomy. During continuous enteral and parenteral nutrition, the stool color became paler. BA was identified by elevated direct bilirubin (DBIL), gamma-glutamyltransferase (GGT), serum matrix metalloproteinase-7 (MMP-7), and hepatobiliary ultrasound; then, Kasai portoenterostomy (KPE) was performed promptly. The Roux-en-Y limb was adjusted intraoperatively to preserve the maximum length of the small intestine while closing the enterostomy. After the operation, the infant gradually adapted to enteral nutrition, his bilirubin level returned to normal, and his weight gradually caught up to the normal range. Although rare, BA should be suspected when MP is combined with IA and when the stool becomes paler in color in the enterostomy state.

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Laparoscopic Management of Congenital Intestinal Obstruction: Duodenal Atresia and Small Bowel Atresia

Cited by 19 publications

References 17 publications

Duodenal Atresia Repair: A Single-Center Comparative Study

Duodenal Atresia Repair: A Single-Center Comparative Study

Diagnosis and surgical management strategy for pediatric small bowel obstruction: Experience from a single medical center

Meconium Peritonitis, Intestinal Atresia Combined With Biliary Atresia: A Case Report

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