Multiple-center study of laparoscopic and open treatment of duodenal atresia

Abstract

To summarize data of a multiple-center study of the treatment of duodenal atresia in 3 children's hospitals of the Siberian Federal District. We analyzed postoperative outcomes in 211 patients with duodenal atresia. All patients underwent surgery at various hospitals of the Siberian Federal District: Ivano-Matreninsky Children's Clinical Hospital in Irkutsk (expert hospital) - 120 patients; Center for Maternal and Child Welfare in Krasnoyarsk (learning hospital No. 1) - 51 patients; Kemerovo Regional Children's Clinical Hospital (learning hospital No. 2) - 40 patients. The study has been carried out for 15 years (from January 2005 and to December 2019). Patients were divided into 2 cohorts: group I - 88 patients (laparoscopic formation of duodenal anastomosis); group II - 123 patients (surgery via laparotomy). Demographic data, intra- and postoperative parameters and complications were analyzed. Preoperative parameters were similar in both groups. Significant between-group differences were found for surgery time (70 vs. 90 min; p<0.001). Initiation of feeding and complete enteral nutrition occurred significantly earlier after laparoscopy (3 vs. 7 days, p<0.001 and 8 vs. 12 days, p<0.001). Incidence of anastomotic leakage significantly differed in both groups (1 patient after laparoscopy and 9 patients after laparotomy, p=0.038). Mortality was absent in the laparoscopy group. In the laparotomy group, this value was 4.9% (p=0.036) and caused by concomitant conditions (prematurity, sepsis, heart defects). Late postoperative complications (adhesive intestinal obstruction, ventral hernias) were absent after laparoscopy and occurred in 5.7% of patients after laparotomy (p=0.023). Laparoscopic correction of duodenal atresia can be safely performed by experienced endoscopic surgeons from different centers united by the same ideology of endoscopic surgery. Laparoscopy ensures less duration of surgery, faster postoperative recovery, less mortality, incidence of early and late postoperative complications.