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)
References
1. Chen Q.J., Gao Z.G., Tou J.F., et al. Congenital duodenal obstruction in neonates: a decade’s experience from one center. World J Pediatr. 2014; 10 (3): 238-44.
2. Kimura K., Tsugawa C., Ogawa K., et al. Diamondshaped anastomosis for congenital duodenal obstruction. Arch Surg. 1977; 112: 1262-3.
3. Bax N.M., Ure B.M., van der Zee D.C., et al. Laparoscopic duodenoduodenostomy for duodenal atresia. Surg Endosc. 2001; 15: 217.
4. Spilde T.L., St Peter S.D., Keckler S.J., et al. Open versus laparoscopic repair of congenital duodenal obstruction: a concurrent series. J Pediatr Surg. 2008; 43: 1002-5.
5. Hill S., Koontz C., Langness S., et al. Laparoscopic versus open repair of congenital duodenal obstruction. J Laparoendosc Adv Surg Tech A. 2011; 21: 961-3.
6. Jensen A.R., Short S.S., Anselmo D.M., Torres M.B., Frykman P.K., Shin C.E., et al. Laparoscopic versus open treatment of congenital duodenal obstruction: multicenter short term outcomes analysis. J Laparoendosc Adv Surg Tech A. 2013; 23: 876-80.
7. Chiarenza S.F., Bucci V., Conighi M.L., et al. Duodenal atresia: open versus MIS repair analysis of our experience over the last 12 years. Biomed Res Int. 2017; 2017: 4585360.
8. Son T., Kien H. Laparoscopic versus open surgery in management of congenital duodenal obstruction in neonates: a single-center experience with 112 cases. J Pediatr Surg. 2017; 52: 1949-51.
9. van der Zee D. Laparoscopic repair of duodenal atresia: revisited. World J Surg. 2011; 35: 1781-4.
10. Parmentier B., Peycelon M., Muller C., El Gho-neimi A., Bonnard A. Laparoscopic management of congenital duodenal atresia or stenosis: a single-center early experience. J Pediatr Surg. 2015; 50: 1833-6.
11. Spilde T.L., St Peter S.D., Keckler S.J., Holcomb G.W. 3rd, Snyder C.L., Ostlie D.J. Open vs laparoscopic repair of congenital duodenal obstructions: a concurrent series. J Pediatr Surg. 2008; 43 (6): 1002-5.
12. Holler A., Muensterer O., Martynov I., Gianicolo E., Lacher M., Zimmermann P. Duodenal atresia repair using a miniature stapler compared to laparoscopic hand-sewn and open technique. J Laparoendosc Adv Surg Tech A. 2019; 29: 1216-22.
13. Kozlov Yu.A., Novozhilov V.A., Rasputin A.A., Syrkin N.V., Podkamenev A.V., Yurkov P.S., et al. Laparoscopic duodenoduodenostomy in the treatment of inborn duodenal obstruction. Preliminary experience. Detskaya khirurgiya [Pediatric Surgery]. 2012; (5): 34-7. (in Russian)