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Surgical Endoscopy

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01-09-2018

Laparoscopic versus open surgery for the repair of congenital duodenal obstructions in infants and children

Authors: Stefan Gfroerer, Till-Martin Theilen, Henning Cornelius Fiegel, Udo Rolle

Published in: Surgical Endoscopy | Issue 9/2018

Abstract

Background

Laparoscopic repair of congenital duodenal obstruction (LCDO) was described more than 15 years ago. However, studies comparing outcomes of LCDO with open repair (OCDO) are rare. Standardized assessments of complications using the Clavien–Dindo classification (CDC) and the comprehensive complication index (CCI) are not available.

Methods

All patients undergoing OCDO or LCDO between 2004 and 2017 were identified from the institutional database by retrospective analysis. Postoperative outcomes were assessed, including all complications using the CDC and the CCI.

Results

Forty-seven consecutive patients were identified; 27 patients underwent LCDO and 20 patients had OCDO. Both groups did not differ regarding demographics, associated congenital anomalies, intraoperative pathologic findings, and operative procedures. LCDO was associated with a longer operative time [mean (SD), 202 (89) vs. 112 (41) min, P < 0.0001], shorter time to initiation of feeds [median (range), 1 (0–4) vs. 3 (1–12) days, P = 0.0027], and shorter time to full feeds [mean (SD), 8.2 (4.1) vs. 12.2 (6.4) days, P = 0.0243] compared to OCDO. Shorter length of postoperative hospital stay in LCDO group was achieved for patients without cardiac anomalies [mean (SD), 9.4 (3.1) days in LCDO group vs. 17.2 (9.4) days in OCDO, P = 0.0396] and patients without other anomalies [median (range), 12 (3–38) days in LCDO group vs. 21 (7–31) days in OCDO, P = 0.0460]. LCDO was associated with a lower CCI [median (range) 0 (0–39.7) vs. 4.3 (0–100), P = 0.0270].

Conclusions

Despite a longer operative time for LCDO, a number of advantages of LCDO over OCDO were recognized comparing both approaches in the repair of congenital duodenal obstruction. Such advantages include a lower morbidity, reduced time to initiation and completion of full enteral feeds, and shorter length of postoperative hospitalization for patients without concomitant cardiac anomalies and for patients without other anomalies when operated laparoscopic. In view of the present results, LCDO, performed in selected patients, appears to represent a viable alternative to OCDO.

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Title: Laparoscopic versus open surgery for the repair of congenital duodenal obstructions in infants and children
Authors: Stefan Gfroerer
Till-Martin Theilen
Henning Cornelius Fiegel
Udo Rolle
Publication date: 01-09-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 9/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6130-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Laparoscopic versus open surgery for the repair of congenital duodenal obstructions in infants and children

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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