Outcomes and survival of infants with congenital duodenal obstruction following Kimura procedure with post-anastomosis jejunostomy feeding tube

Abstract

Background Several modifications of the Kimura procedure for congenital duodenal obstruction (CDO) have been reported, however, their effects on the outcomes show conflicting results. Methods We compared the CDO outcomes following the Kimura procedure with and without post-anastomosis jejunostomy feeding tube (JFT). Results A total of 52 CDO neonates were involved (JFT: 13 males and 2 females vs. non-JFT: 14 males and 23 females, p = 0.0019). Time to full oral feeding was significantly earlier in the JFT than non-JFT group (14 [interquartile range (IQR), 12–15] vs. 17 [IQR, 14–22.5] days; p = 0.04). Duration of parenteral nutrition given to infants with CDO after surgery was significantly shorter in the JFT than non-JFT group (12 [IQR, 10–15] vs. 17 [IQR, 13–23] days; p = 0.031). Moreover, enteral feeding was significantly earlier in the JFT than non-JFT group (2 [IQR, 1–3.5] vs. 5 [IQR, 4–6] days; p = < 0.0001). However, the length of stay following surgery was not significantly different between groups (16 [IQR, 14–22] vs. 20 [IQR, 17–28] days; p = 0.22). Also, overall patient survival did not significantly differ between JFT (66.7%) and non-JFT patients (59.5%) (p = 0.61). Conclusion Jejunostomy feeding tube shows a beneficial effect on the time to full oral feeding, duration of parenteral nutrition and early enteral feeding in neonates with congenital duodenal obstruction after Kimura procedure.

Cardiac anomalies in children with congenital duodenal obstruction: a systematic review with meta-analysis

“…In total, 70 studies with a total of 4169 patients described the type of DO (Fig. 3 ) [ 1 , 6 , 10 – 12 , 16 – 19 , 21 – 25 , 27 – 32 , 34 – 52 , 54 – 57 , 59 , 62 – 65 , 67 , 70 – 75 , 81 – 83 , 85 , 89 , 90 , 93 – 95 , 98 – 100 , 102 , 105 , 106 ]. Type 3 DO consisting of complete atresia, was the most frequent obstruction and occurred in a pooled percentage of 54% of patients with DO (95% CI 0.478–0.603; I 2 = 88%; p < 0.001) of the children.…”

“…The following period between 2000 and 2009 included 17 studies with 970 patients and had a calculated pooled proportion of 32% percent (95% CI 0.243–0.407; I 2 = 82%; p = 0.000) [ 12 , 14 , 22 , 23 , 28 , 29 , 37 , 45 , 48 , 49 , 62 , 67 , 73 , 74 , 85 , 90 , 106 ]. The last period between 2010 and present included 47 studies with 3747 patients [ 1 , 6 , 16 , 18 – 21 , 24 – 27 , 31 , 35 , 36 , 42 , 46 , 47 , 50 , 52 , 53 , 55 , 57 – 59 , 68 , 69 , 71 , 72 , 77 , 78 , 81 – 84 , 87 , 88 , 91 – 95 , 97 , 98 , 100 , 103 – 105 ]. For this period, the pooled percentage for cardiac anomalies was 34% percent (95% CI 0.290–0.392; I 2 = 89%; p = 0.000).…”

Congenital Duodenal Obstruction: National Trends in Management and Outcomes during the Last Quarter of a Century in Norway

“…LOS in this study is in the lower range of what is reported from recent studies on CDO. 1,15,23 This suggests that also other institutions have been unsuccessful in reducing LOS in this patient population. The main factors keeping CDO patients in the hospital are the time to achieve full oral feeds and postoperative complications.…”

Double Whammy: Duodenal Stenosis and Gastrointestinal Malrotation

“…Duodenoduodenostomy or Kimura’s procedure is often described as the surgery of choice for duodenal stenosis, introduced in 1977. Kimura described a method to bypass the stenosis by applying a diamond-shaped side-to-side duodenoduodenostomy [ 4 ] with good outcomes for congenital duodenal obstruction [ 5 ]. Some variation was also described later on with the introduction of post-anastomosis jejunostomy feeding and more recently the inverted duodenoduodenostomy (i-DSD) [ 6 ], but the main gist of the surgical procedure is to bypass the stenosis segment.…”