Trans-anastomotic tubes reduce the need for central venous access and parenteral nutrition in infants with congenital duodenal obstruction

Hall, Nigel; Drewett, Melanie; Wheeler, Robert; Griffiths, D.M.; Kitteringham, Lara; Burge, D.M.

doi:10.1007/s00383-011-2896-2

Cited by 41 publications

(31 citation statements)

References 4 publications

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“…15 The reported median times to full postanastomotic feeds are similar to our findings for full oral and gastric feeds after MIS repair 13 ; placing a TAT tube has not been shown to reduce time to full preanastomotic feeds. 14 Furthermore, the potential benefits of a TAT need to be weighed carefully with its associated risks such as displacement or perforation, 13,16 which should be set against the potential to reduce the rate of line sepsis 13 and PN-related cholestasis. 11 Despite the clearly earlier feeding after laparoscopic repair compared with open surgery in our cohort, the postoperative length of hospital stay was not significantly shorter in the first group.…”

Section: Discussionsupporting

confidence: 72%

“…Placing a TAT is another means by which enteral (i.e., postanastomotic) feeds can be advanced more quickly after surgery. 13,14 While they might reduce the need for PN, however, TATs have not been proven to reduce time to full preanastomotic feeds or to reduce the length of hospital stay. 15 The reported median times to full postanastomotic feeds are similar to our findings for full oral and gastric feeds after MIS repair 13 ; placing a TAT tube has not been shown to reduce time to full preanastomotic feeds.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 While they might reduce the need for PN, however, TATs have not been proven to reduce time to full preanastomotic feeds or to reduce the length of hospital stay. 15 The reported median times to full postanastomotic feeds are similar to our findings for full oral and gastric feeds after MIS repair 13 ; placing a TAT tube has not been shown to reduce time to full preanastomotic feeds. 14 Furthermore, the potential benefits of a TAT need to be weighed carefully with its associated risks such as displacement or perforation, 13,16 which should be set against the potential to reduce the rate of line sepsis 13 and PN-related cholestasis.…”

Section: Discussionmentioning

confidence: 99%

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Potential Benefits of Laparoscopic Repair of Duodenal Atresia: Insights from a Retrospective Comparative Study

et al. 2019

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Introduction Congenital duodenal obstruction (CDO) repair can be performed open or laparoscopically. We aimed to determine the potential benefit of laparoscopic repair regarding tolerance of enteral feeding, postoperative pain, hospital stay, and complication rate. Materials and Methods In a single-center retrospective cohort study, we compared neonates with isolated CDO operated open versus laparoscopically from 2010 to 2019. No transanastomotic tubes were used, and anastomoses were created in a side-to-side fashion in all cases. An early feeding policy is applied for all cases operated at our institution. Statistical comparison was performed using the Mann–Whitney's test or Fisher's exact test where appropriate. Results Forty-one patients analyzed were similar regarding body weight, gestational age, and proportion of patients with trisomy 21. Median follow-up was 21 months. Four (20%) out of 20 laparoscopic procedures started laparoscopically were converted to open. Comparing the 21 open with the 16 laparoscopically completed patients, median anesthetic duration was shorter by 18% in the open versus laparoscopic completed group (218 vs. 179 minutes, respectively; p = 0.025). Median postoperative time to full enteral feeds was shorter by 4 days in the first group (7 vs. 11 days, respectively; p = 0.028). In accordance, the median duration of parenteral nutrition (PN) was less than half in the laparoscopic completed compared with the open group (5 vs. 11.5 days, respectively; p = 0.031). Postoperative opioids were required for only half the duration in the laparoscopically completed group compared with open (2 vs. 4 days, respectively; p = 0.026). Outcomes such as length of stay, the occurrence of strictures or adhesions requiring reintervention, or line sepsis were similar in both groups. Conclusion Patients undergoing laparoscopic CDO repair at our institution benefited from shorter time to full enteral feeds, and reduced the need for PN as well as postoperative pain medication.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Potential Benefits of Laparoscopic Repair of Duodenal Atresia: Insights from a Retrospective Comparative Study

et al. 2019

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“…Post-operatively, parenteral nutrition can usually be avoided and some centres advocate placement of a trans-anastomotic tube to facilitate early jejunal feed whilst normal gastro-duodenal function resumes [10]. There is an associated mortality rate of around 5% with DA; this is related to the high rate of associated anomalies.…”

Section: Duodenal Atresiamentioning

confidence: 95%

Malrotation and intestinal atresias

Adams

Stanton

2014

Early Human Development

128

106

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“…Under the circumstances we selected antiperistaltic loop direct anastomosis which led to increased aspirates temporarily in the postoperative period. The passage of trans anastomotic tube across the anastomosis may have helped in starting the nasojejunal feeds early and may have helped avoiding insertion of the central line as shown by recent studies in reducing the need for the central line and total parenteral nutrition [15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Distal duodenal stenosis in Down's syndrome - a rare challenge

Patel¹,

Philip²

2017

JPSS

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We present a case of distal duodenal stenosis without a wind sock deformity in a Down's syndrome presenting with non-bilious vomiting, constipation and bilious aspirates simulating Hirschsprung's disease. Despite high index of suspicion and actively looking for associated congenital duodenal obstruction it eluded detection. The plain film and rectal biopsy in neonatal period were normal. It was the upper gastrointestinal study which helped in diagnosis. At exploration, distal duodenal stenosis without wind sock deformity was identified. Duodeno-jejunostomy was curative.

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Trans-anastomotic tubes reduce the need for central venous access and parenteral nutrition in infants with congenital duodenal obstruction

Abstract: A TAT significantly shortens time to full enteral feeds in infants with CDO significantly reducing the need for central venous access and PN.

Cited by 41 publications

References 4 publications

Potential Benefits of Laparoscopic Repair of Duodenal Atresia: Insights from a Retrospective Comparative Study

Potential Benefits of Laparoscopic Repair of Duodenal Atresia: Insights from a Retrospective Comparative Study

Malrotation and intestinal atresias

Distal duodenal stenosis in Down's syndrome - a rare challenge

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