Duodenal Obstruction

Abstract

The duodenum is the most common site of neonatal intestinal obstruction, accounting for 50% of all intestinal atresias. Duodenal Obstruction (DO) is often complicated by associated anomalies and prematurity. Approximately half of all cases are detected antenatally on fetal ultrasonography, which allows the mother karyotype analysis for trisomy 21 (Down syndrome) and other associated anomalies. Cardiac malformations are the major cause of morbidity and mortality in patients with congenital DO. For most causes of congenital DOs, duodenoduodenostomy via an open approach is the preferred surgical procedure. Vidal from France and Ernest from the Netherlands are credited with the first successful repairs in 1905 and 1914, respectively. Over the last two decades, the application of minimally invasive surgical techniques (MIS) and the advent of smaller laparoscopic instruments have expanded the potential of laparoscopy for the repair of congenital DO. The first reported laparoscopic repairs of duodenal atresia were by (Bax NM, Ure BM, van der Zee DC, Surg Endosc. 15:217, 2001) and (Rothenberg SS, J Pediatr Surg. 37:1088–9, 2002). The last retrospective studies comparing the surgical outcome of laparoscopic repair versus open repair found that laparoscopy is a safe and effective technique, and the results, including time to full feeding, length of stay, and complication rate, were similar in both groups; however, laparoscopy was associated with a longer operative time. The long-term survival rate of patients with DO is excellent and greater than 95%, resulting from an early surgical intervention combined with advancement in neonatal intensive care, anesthesia, and nutritional support.