Clinical impact of open versus laparoscopic approach on the outcome in cases of congenital duodenal obstruction: A comparative study

Abstract

Introduction Congenital duodenal atresia/partial duodenal obstruction/duodenal stenosis is one of the most common variants of intestinal atresia, occurring 1 in 2500–5000 live births. The aim of this study was to compare between both the laparoscopic and open approaches for repair of congenital duodenal obstruction regarding their effects on outcome.
Patients and methods A total of 20 cases diagnosed with congenital duodenal obstruction (atresia, web, and stenosis) in the neonatal and pediatric surgical units of Cairo University Specialized Pediatric Hospital were studied. All cases underwent either laparoscopic or open repair. Cases associated with malrotation or multiple atresias were excluded. Patients’ characteristics, including age, sex, presenting symptoms, associated anomalies, preoperative investigations, intraoperative details, and postoperative outcomes, were documented.
Results A total of 20 cases of duodenal obstruction were included in this study over 1 year, from January 2017 to January 2018. We did duodenoduodenostomy in 15 cases (web in the second part of duodenum, types II and III) and excision of the web in the first part of duodenum in five cases. Laparoscopic repair was done in 11 (55%) cases (diamond-shaped duodenoduodenostomy in nine cases and web excision in two cases) whereas open technique was performed in nine (45%) cases (diamond duodenoduodenostomy in six cases, and excision of the web in three cases). The average operative time in cases of laparoscopic duodenoduodenostomy was 120 min whereas in the cases of open technique was 90 min. The average time needed until full feeding to be achieved was 6–7 days in cases done  laparoscopically, whereas other group was 10–20 days. In this cohort, no stricture or leakage or wound dehiscence was found in both groups. Laparoscopic group afforded a better cosmesis and more parent satisfaction.
Conclusion Use of the laparoscope in duodenal obstruction in either neonates or children is a safe and easy technique, and despite being a lengthier operation, feeding could be established earlier. 

Keywords: duodenal atresia, laparoscopic, TPN