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2 . 2021

Comparative analysis of laparoscopic and open treatment of duodenal atresia

Abstract

Background. Laparoscopic reconstruction of atresia of the duodenum is a complex procedure involving the implementation of a hermetic anastomosis in a small workspace. The disadvantages of this approach are high rates of insolvency and a long operation time. In this article, we evaluate our experience of endosurgical treatment of duodenal atresia and compare it with a historical cohort of open treatment. The presented series of laparoscopic treatment of duodenal atresia is the largest published to date in the world.

Material and methods. The study performed a retrospective analysis of all patients who underwent surgery for duodenal atresia over a period of time from January 1, 2005 till December 31, 2019. A total of 128 operations were performed, of which 69 were laparoscopic. The design of the intestinal anastomosis was presented by Kimura's diamond-shaped anastomosis and 3/4 membranectomy with an anastomosis. In the final part of the study, anthropometric data, intra- and postoperative parameters, and treatment complications were statistically analyzed.

Results. The median age and weight in the comparison groups were comparable. The operation time was significantly shorter in the laparoscopic group compared with the open surgery group [70 (60; 80) versus 90 (80; 100) min; p<0.001]. The time of initiation of feeding and the transition to full enteral nutrition were significantly shorter in the laparoscopy group when compared with the open approach [3 (2; 5.5) versus 7 (5; 7) days, p<0.001 and 8 (5; 10) versus 11 (10; 12) days, p<0.001]. The level of complications in the compared groups did not differ significantly (p=0.092). Mortality was 0 and 1.7%, respectively, and was due to a concomitant condition - sepsis. Late postoperative complications (anastomotic stenosis, adhesive intestinal obstruction, gastroesophageal reflux) did not occur in laparoscopy patients and were observed in 5.1% of laparotomy patients (p=0.095).

Conclusion. Laparoscopic treatment of duodenal atresia is a safe and effective method, which is accompanied by significantly shorter surgery time and faster patient recovery.

Keywords:duodenal atresia, laparoscopy, Kimura anastomosis, membranectomy, newborns

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Kozlov Yu.A., Rasputin A.A., Baradieva P.A., Cheremnov V.S., Ochirov Ch.B., Zvonkov D.A., Kovalkov K.A., Poloyan S.S., Chubko D.M., Kapuller V.M., Vinogradov K.A. Comparative analysis of laparoscopic and open treatment of duodenal atresia. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (2): 117-25. DOI: https://doi.org/10.33029/2308-1198-2021-9-2-117-125  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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