Advertisement

Pediatric Surgery International

, Volume 35, Issue 1, pp 151–157 | Cite as

Duodenal atresia and associated intestinal atresia: a cohort study and review of the literature

  • Maria Enrica Miscia
  • Giuseppe Lauriti
  • Pierluigi Lelli Chiesa
  • Augusto Zani
Original Article
  • 109 Downloads

Abstract

Purpose

To determine the true incidence of associated intestinal atresia (AIA) in infants with duodenal atresia (DA) and to analyze whether the surgical approach, open versus laparoscopic, would impact on patient outcome when AIA is present.

Methods

Cohort study We review all DA infants treated at our institution (2001–2016) and analyzed the outcome of those with AIA. Systematic review/meta-analysis Using a defined search strategy and according to PRISMA guidelines, two investigators independently identified all studies on DA and searched cases of AIA to determine its incidence. Data are mean ± SD.

Results

Cohort study Of 140 DA infants, 10 (7%) had AIA (4 type I, 4 type III, 2 type II). All type I AIA (webs) were found in the duodenum. Systematic review/meta-analysis Of 840 studies, 18 were included (2026 infants). The incidence of AIA was 2.8 ± 1.6%. The incidence of missed AIA was 0.8 ± 2.4%. Three comparative studies (759 infants) showed higher risk of missed AIA following laparoscopic (2.9 ± 2.4%) than open repair (0.3 ± 0.1%; p < 0.01).

Conclusions

The incidence of AIA in DA infants is low and the risk of missing it is higher at laparoscopy than at laparotomy. Regardless the approach, surgeons should carefully investigate bowel continuity to avoid the risk of missing AIA.

Keywords

Jejunal atresia Ileal atresia Cohort study Systematic review Meta-analysis 

Notes

Funding

This study was not funded by any grant.

Compliance with ethical standards

Conflict of interest

Authors have no potential conflicts of interest for this study.

Ethical approval

Ethical approval REB #1000055682. Not applicable in the Systematic Review and Meta-Analysis.

Informed consent

Not applicable, since the study was a review of the medical charts of patients, plus a Systematic Review and Meta-Analysis.

Supplementary material

383_2018_4387_MOESM1_ESM.docx (29 kb)
Supplementary material 1 (DOCX 29 KB)

References

  1. 1.
    Escobar MA, Ladd AP, Grosfeld JL et al (2004) Duodenal atresia and stenosis: long-term follow-up over 30 years. J Pediatr Surg 39:867–871CrossRefGoogle Scholar
  2. 2.
    Parmentier B, Peycelon M, Muller CO et al (2015) Laparoscopic management of congenital duodenal atresia or stenosis: a single-center early experience. J Pediatr Surg 50:1833–1836CrossRefGoogle Scholar
  3. 3.
    Grosfeld JL, Rescorla FJ (1993) Duodenal atresia and stenosis: reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long-term follow-up. World J Surg 17:301–309CrossRefGoogle Scholar
  4. 4.
    Choudhry MS, Rahman N, Boyd P et al (2009) Duodenal atresia: associated anomalies, prenatal diagnosis and outcome. Pediatr Surg Int 25:727–730CrossRefGoogle Scholar
  5. 5.
    Burjonrappa S, Crete E, Bouchard S (2011) Comparative outcomes in intestinal atresia: a clinical outcome and pathophysiology analysis. Pediatr Surg Int 27:437–442CrossRefGoogle Scholar
  6. 6.
    Chiarenza SF, Bucci V, Conighi ML et al (2017) Duodenal atresia: open versus MIS repair-analysis of our experience over the last 12 years. Biomed Res Int 2017:4585360CrossRefGoogle Scholar
  7. 7.
    Mustafawi AR, Hassan ME (2008) Congenital duodenal obstruction in children: a decade’s experience. Eur J Pediatr Surg 18:93–97CrossRefGoogle Scholar
  8. 8.
    Rattan KN, Singh J, Dalal P (2016) Neonatal duodenal obstruction: a 15-year experience. J Neonatal Surg 5:13Google Scholar
  9. 9.
    Murshed R, Nicholls G, Spitz L (1999) Intrinsic duodenal obstruction: trends in management and outcome over 45 years (1951–1995) with relevance to prenatal counselling. Br J Obstet Gynaecol 106:1197–1199CrossRefGoogle Scholar
  10. 10.
    Kimura K, Mukohara N, Nishijima E et al (1990) Diamond-shaped anastomosis for duodenal atresia: an experience with 44 patients over 15 years. J Pediatr Surg 25:977–979CrossRefGoogle Scholar
  11. 11.
    Zani A, Yeh JB, King SK et al (2017) Duodeno-duodenostomy or duodeno-jejunostomy for duodenal atresia: is one repair better than the other? Pediatr Surg Int 33:245–248CrossRefGoogle Scholar
  12. 12.
    Kay S, Yoder S, Rothenberg S (2009) Laparoscopic duodenoduodenostomy in the neonate. J Pediatr Surg 44:906–908CrossRefGoogle Scholar
  13. 13.
    Spilde TL, St Peter SD, Keckler SJ et al (2008) Open vs laparoscopic repair of congenital duodenal obstructions: a concurrent series. J Pediatr Surg 43:1002–1005CrossRefGoogle Scholar
  14. 14.
    Van der Zee DC (2011) Laparoscopic repair of duodenal atresia: revisited. World J Surg 35:1781–1784CrossRefGoogle Scholar
  15. 15.
    MacCormack BJ, Lam J (2016) Laparoscopic repair of congenital duodenal obstruction is feasible even in small-volume centres. Ann R Coll Surg Engl 98:578–580CrossRefGoogle Scholar
  16. 16.
    St Peter SD, Little DC, Barsness KA et al (2010) Should we be concerned about jejunoileal atresia during repair of duodenal atresia? J Laparoendosc Adv Surg Tech A 20:773–775CrossRefGoogle Scholar
  17. 17.
    Sweeney B, Surana R, Puri P (2001) Jejunoileal atresia and associated malformations: correlation with the timing of in utero insult. J Pediatr Surg 36:774–776CrossRefGoogle Scholar
  18. 18.
    Applebaum H, Sydorak R (2012) Duodenal atresia and stenosis-annular pancreas. Chapter 81. In: Coran AG, Caldamone A, Adzick NS, Krummel TM, Laberge JM, Shamberger R (eds) Pediatric surgery, 7th edn. Elsevier Inc, Philadelphia, pp 1051–1058CrossRefGoogle Scholar
  19. 19.
    Rothenberg SS (2002) Laparoscopic duodenoduodenostomy for duodenal obstruction in infants and children. J Pediatr Surg 37:1088–1089CrossRefGoogle Scholar
  20. 20.
    Gray SW, Skandalakis JE (1972) Embryology for surgeons: the embryological basis for treatment of congenitaldefects. WB Saunders, Philadelphia, pp 177–217Google Scholar
  21. 21.
    Bland-Sutton JD (1889) Imperforate ileum. Am J Med Sci 98:457–462CrossRefGoogle Scholar
  22. 22.
    Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRefGoogle Scholar
  23. 23.
    PROSPERO International Prospective Register of Systematic Reviews. http://www.crd.york.ac.uk/prospero/about.php?about=about. Accessed 15th Apr 2018
  24. 24.
    Review Manager (RevMan). 5.3. (2014) The Nordic Cochrane Centre, The Cochrane Collaboration, CopenhagenGoogle Scholar
  25. 25.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13CrossRefGoogle Scholar
  26. 26.
    Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefGoogle Scholar
  27. 27.
    Shea BJ, Grimshaw JM, Wells GA et al (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:10CrossRefGoogle Scholar
  28. 28.
    Weber TR, Lewis JE, Mooney D et al (1986) Duodenal atresia: a comparison of techniques of repair. J Pediatr Surg 21:1133–1136CrossRefGoogle Scholar
  29. 29.
    Spigland N, Yazbeck S (1990) Complications associated with surgical treatment of congenital intrinsic duodenal obstruction. J Pediatr Surg 25:1127–1130CrossRefGoogle Scholar
  30. 30.
    Dalla Vecchia LK, Grosfeld JL, West KW et al (1998) Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg 133:490–496CrossRefGoogle Scholar
  31. 31.
    Lawrence MJ, Ford WD, Furness ME et al (2000) Congenital duodenal obstruction: early antenatal ultrasound diagnosis. Pediatr Surg Int 16:342–345CrossRefGoogle Scholar
  32. 32.
    Rao KL, Chowdhary SK, Suri S et al (2001) Duodenal atresia: outcome analysis from a regional neonatal center. Indian Pediatr 38:1277–1280Google Scholar
  33. 33.
    Sarin YK, Sharma A, Sinha S et al (2012) Duodenal webs: an experience with 18 patients. J Neonatal Surg 1:20Google Scholar
  34. 34.
    Jensen AR, Short SS, Anselmo DM et al (2013) Laparoscopic versus open treatment of congenital duodenal obstruction: multicenter short-term outcomes analysis. J Laparoendosc Adv Surg Tech A 23:876–880CrossRefGoogle Scholar
  35. 35.
    Chen QJ, Gao ZG, Tou JF et al (2014) Congenital duodenal obstruction in neonates: a decade’s experience from one center. World J Pediatr 10:238–244CrossRefGoogle Scholar
  36. 36.
    Kumar P, Kumar C, Pandey PR et al (2016) Congenital duodenal obstruction in neonates: over 13 years’ experience from a single centre. J Neonatal Surg 5:50CrossRefGoogle Scholar
  37. 37.
    Cho MJ, Kim DY, Kim SC et al (2017) Transition from laparotomy to laparoscopic repair of congenital duodenal obstruction in neonates: our early experience. Front Pediatr 5:203CrossRefGoogle Scholar
  38. 38.
    Li B, Chen WB, Zhou WY (2013) Laparoscopic methods in the treatment of congenital duodenal obstruction for neonates. J Laparoendosc Adv Surg Tech A 23:881–884CrossRefGoogle Scholar
  39. 39.
    Chung PH, Wong CW, Ip D et al (2017) Is laparoscopic surgery better than open surgery for the repair of congenital duodenal obstruction? A review of the current evidences. J Pediatr Surg 52:498–503CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Maria Enrica Miscia
    • 1
    • 2
    • 3
  • Giuseppe Lauriti
    • 2
    • 3
  • Pierluigi Lelli Chiesa
    • 2
    • 3
  • Augusto Zani
    • 1
  1. 1.Division of General and Thoracic SurgeryThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Department of Pediatric Surgery“Spirito Santo” HospitalPescaraItaly
  3. 3.“G. d’Annunzio” University, Chieti-PescaraChietiItaly

Personalised recommendations