Transanastomotic Tube Research Articles

Repair of Type C Tracheo-esophageal Fistula/Esophageal Atresia With or Without Trans Anastomotic Tube: A Pilot Randomized Controlled Trial

BackgroundThe use of trans anastomotic feeding tube (TAFT) during the repair of Esophageal atresia/Tracheo-esophageal fistula (EA/TEF) aims to enhance outcomes by enabling early feeding, reducing the requirement for parenteral nutrition, and reducing complications such as anastomotic leak by stenting the anastomosis. However, TAFT's benefits and drawbacks are debated due to conflicting reports. Thus, we conducted a prospective pilot randomized control trial to elucidate the impact of TAFT on postoperative outcomes and the potential benefits of avoidance of TAFT. MethodsWe performed a single-center randomized controlled trial in 53 neonates diagnosed with Type C EA/TEF who were operated on from January 2022 to June 2023. The patients were randomized into TAFT (n = 30) and non-TAFT (n = 23) groups. The patients were followed up for a minimum of 6 months following discharge. The primary objective of the study was to compare the rate of anastomotic leaks following primary repair of EA/TEF in both groups. Secondary objectives included early postoperative outcomes such as the occurrence of anastomotic stricture, time taken to initiate feeding, the time required to reach full feeding, the incidence of brief resolved unexplained events (BRUE) or acute life-threatening events (ALTE), the incidence of gastroesophageal reflux (GER), somatic growth, and all-cause mortality within 30 days post-surgery. ResultThe study demonstrated that TAFT placement was associated with a higher incidence of anastomotic leaks (20 % vs 0, p = 0.03). However, there was no difference in the 30-day mortality between both groups. Although the rate of anastomotic strictures and GER was higher in the TAFT group (54.5 % vs 27.8 %, p = 0.08 and 25 % vs 57.1 %, p = 0.076), it did not reach statistical significance. Avoiding TAFT resulted in earlier initiation of enteral feeding (18 vs 22 days, p = 0.002), shorter time to achieve full feeds (15 vs 21 days, p = 0.03), reduced duration of TPN (3 vs 10 days; p = 0.001), improved weight gain at the 2-week follow-up (27.5 vs. 24.4 g/kg/day, p-value = 0.037) and lesser incidence of ALTE/BRUE (11.1 % vs 48 %, p = 0.01) at 6 months. ConclusionWhile previous research has covered TAFT's impact on complications such as anastomotic leak, stricture, use of TPN and enteral feed, prospective randomized studies remain limited, and the impact on GER, somatic growth, and occurrence of ALTE/BRUE is still unexplored. This study evaluated the short-term outcomes of EA/TEF in a resource-challenged setting, shedding light on the potential benefits of repair without TAFT such as reduction in the rate of anastomotic leak, earlier feeding, reduced GER, better somatic growth and reduced incidence of ALTE/BRUE. Level of EvidenceLevel II (Treatment study/Randomized controlled trial).

The beneficial effects of the transanastomotic feeding tube in the management of congenital duodenal obstruction: a meta-analysis

The beneficial effects of the transanastomotic feeding tube in the management of congenital duodenal obstruction: a meta-analysis

Congenital duodenal obstruction repair with and without transanastomotic tube feeding: a systematic review and meta-analysis

ObjectiveTo determine the impact of transanastomotic tube (TAT) feeding in congenital duodenal obstruction (CDO).DesignSystematic review with meta-analysis.PatientsInfants with CDO requiring surgical repair.InterventionsTAT feeding following CDO repair versus no TAT feeding.Main...

A Minimally Interventional Approach to Oesophageal Atresia Repair With Early Enteral Feeding is Safe, Optimises Neonatal Outcomes, and Reduces Resource use

PurposeRecent series of newborn Oesophageal Atresia (OA) repair continue to report widespread use of chest drains, gastrostomy, routine contrast studies and parenteral nutrition (PN) despite evidence suggesting these are superfluous. We report outcomes using a minimally interventional approach to post-operative recovery. MethodsEthically approved (15/WA/0153), single-centre, retrospective case-note review of consecutive infants with OA 2000–2022. Infants with OA and distal trache-oesophageal fistula undergoing primary oesophageal anastomosis at initial surgery were included (including those with comorbidities such as duodenal atresia, anorectal malformation and cardiac lesions). Our practice includes routine use of a trans-anastomotic tube (TAT), no routine chest drain nor gastrostomy, early enteral and oral feeding, no routine PN and no routine contrast study. Data are median (IQR). ResultsOf total 186 cases of OA treated during the time period, 157 met the inclusion criteria of which 2 were excluded as casenotes unavailable. TAT was used in 150 infants. A chest drain was required in 13 (8%) and two infants had a neonatal gastrostomy. Enteral feeds were started on postoperative day 2 (2–3), full enteral feeds established by day 4 (4–6) and oral feeds started on day 5 (4–8). PN was required in 15%. Median postoperative length of stay was 10 days (8–17). Progress was quicker in term infants than preterm. One infant died of cardiac disease prior to neonatal discharge. Two planned post-operative contrast studies were performed (surgeon preference) and a further 7 due to clinical suspicion of anastomotic leak. Contrast study was therefore avoided in 94%. There were 2 anastomotic leaks; both presented clinically at day 4 and day 8 after oral feeds had been started. ConclusionOur minimally interventional approach is safe. It facilitates prompt recovery with lower resource use, reduced demand on nursing staff, reduced radiation burden, and early discharge home compared to published series without adversely affecting outcomes. Level of EvidenceLevel 4.

The beneficial effects of the transanastomotic feeding tube in the management of congenital duodenal obstruction: a meta-analysis.

We aimed to assess the evidence on the efficacy and safety of transanastomotic feeding tubes (TAFTs) in neonates with congenital duodenal obstruction (CDO), we conducted a systematic review. Using the databases EMBASE, PubMed, and Cochrane, we carried out a thorough literature search up to 2022. Studies comparing TAFT + and TAFT - for CDO were included. We applied a random effect model. 505 CDO patients who met the inclusion criteria were selected. The TAFT + group had a shorter time to reach full feeds (weighted mean difference [WMD]: -6.63, 95% confidence interval [CI]: -8.83 - -4.43; p < 0.001) and had significantly less central venous catheter (CVC) insertion (I2 = 85%) (RR: 0.43, 95% CI: 0.19-1.00; p < 0.05). Fewer patients in the TAFT + group received parenteral nutrition (PN) (I2 = 78%) (RR: 0.43, 95% CI: 0.20-0.95; p < 0.05). There was no statistically significant difference in terms of the development of sepsis (I2 = 37%) (risk ratio [RR]: 1.35, 95% CI: 0.52-3.46; p > 0.05). No statistically significant difference was observed in terms of length of stay (I2 = 82%) (WMD: 2.22, 95% CI: -7.59-12.03; p > 0.05) and mortality (I2 = 0%) (RR: 0.55, 95% CI: 0.07-4.34; p > 0.05). The use of the transanastomotic tube resulted in early initiation of full feeding, less CVC insertion, and less need for PN.

Transanastomotic tube placement to prevent complications after anterior resection

Anastomotic leak after anterior resection is associated with increased morbidity and mortality. Although few studies have shown that transanastomotic tube placement after anterior resection may reduce the risk of anastomotic leak and other complications, this approach has not been commonly practiced. Thus, this study evaluated the efficacy of transanastomotic tube placement to prevent complications after anterior resection. This retrospective study evaluated postoperative complications in 71 patients after anterior resection performed using a circular stapler. From January 2013 to December 2015, patients did not receive a transanastomotic tube, and from January 2016 to December 2020, a transanastomotic tube was placed in all patients. These patients were followed-up until discharge. Several patient and treatment factors were compared between patients who underwent anastomosis with and without tube placement. Transanastomotic tube was placed in 49/71 patients. The incidence of postoperative complications was significantly lower in patients with transanastomotic tube (p = 0.008 [univariable]; p = 0.013 [multivariable; odds ratio, 0.144 (0.031–0.667)]), and these patients passed stool significantly earlier (p = 0.003). There was no difference in other patient and treatment/surgical factors between patients with and without postoperative complications. Transanastomotic tube placement is a simple procedure that facilitates the early return of bowel activity and reduces the incidence of complications after anterior resection.

Factors associated with cholestasis after surgery for congenital duodenal atresia

Background: This study assessed the characteristics of neonates with duodenal atresia (DA) who developed transient postoperative cholestasis which resolved spontaneously, without identifiable congenital anomalies or surgical complications, and identified potential risk factors for cholestasis. Methods: Neonates with DA who underwent surgery at our institution between January 2009 and July 2022 were retrospectively reviewed. Demographic factors, intraoperative findings, placement of a trans-anastomotic tube (TAT), and postoperative outcomes were compared between patients who developed cholestasis (conjugated hyperbilirubinemia &gt;2.0 mg/dL) after surgery (Group A) and those who did not (Group B). This report is a retrospective cohort study and complies with the STROBE statement. Results: Among 19 neonates with DA, 6 (31.6%) developed cholestasis after surgery, with the highest direct bilirubin value being 4.3 (2.4-6.5) mg/dL (median, [range]) on postoperative day 14.5 (2-23) that persisted for 67 (47-116) days until spontaneous resolution. Neonates in Group A had a significantly younger gestational age (36.6 vs. 38.0 weeks) (median) (p=0.038), a higher rate of Down syndrome (66.7 vs. 15.4%) (p=0.046), a higher rate of TAT placement (66.7 vs. 15.4%) (p=0.046), and longer administration of total parenteral nutrition (15.5 vs. 7.0 days) (p=0.027) than those in Group B. Conclusion: Transient cholestasis after surgery for DA seemed to be associated with prematurity, Down syndrome, parenteral nutrition, and TAT placement.

Trans-Anastomotic Drainage Tube Placement After Hand-Sewn Anastomosis in Patients Undergoing Intersphincteric Resection for Low Rectal Cancer: An Alternative Drainage Method.

Anastomotic leakage (AL) is a common complication after intersphincteric resection (ISR). It significantly reduces quality of life and causes great distress to patients. Although traditional drainage (e.g., anal and pelvic catheters) may reduce the impact of AL to some extent, their role in reducing the incidence of AL remains controversial. In this study, we developed a novel drainage technique involving the placement of drainage tubes through the gap between sutures during handsewn anastomosis, to reduce the occurrence of anastomotic leakage. We retrospectively analyzed 34 consecutive patients who underwent intersphincteric resection requiring handsewn anastomosis between February 1, 2017, and January 1, 2021. Patients were classified into the trans-anastomotic drainage tube group (TADT, n = 14) and the non-TADT group (n = 20) based on whether trans-anastomotic tube placement was performed. The incidence of postoperative complications, such as AL, was compared between the two groups, and anal function of patients at 1-year post-ISR was evaluated. Six cases of AL occurred in the non-TADT group, while none occurred in the TADT group; this difference was statistically significant (p=0.031). The TADT group also had a shorter hospital stay (p=0.007). There were no other significant intergroup differences in operation time, blood loss, pain score, anastomotic stenosis, intestinal obstruction, or incidence of wound infection. In the 30 patients (88.2%) evaluated for anal function, there were no significant intergroup differences in stool frequency, urgency, daytime/nocturnal soiling, Wexner incontinence score, or Kirwan grading. Taken together, trans-anastomotic tube placement is a novel drainage method that may reduce AL after ISR requiring handsewn anastomosis and without adversely affecting anal function.

Apple-peel intestinal atresia treated by diamond-shaped anastomosis to adjust the anastomosis size

An apple-peel intestinal atresia is a rare form of bowel atresia. Herein, reported a case of apple-peel intestinal atresia that was treated with a diamond-shaped anastomosis to adjust the anastomosis size. A female infant was born at 33 weeks of gestation with a birth weight of 1936 g. The prenatal ultrasound revealed proximal intestinal dilatation and polyhydramnios. She had a prenatal diagnosis of suspected congenital jejunal atresia. Post-natal abdominal X-ray showed triple bubble sign with the paucity of gas in the lower bowel, as well as concerned proximal bowel obstruction. She underwent surgical repair for jejunal atresia at 2 days of age. Surgical exploration revealed a markedly distended atretic jejunum with apple-peel jejunal atresia and a significant loss of intestinal length. A difference in the diameter of approximately 3: 1 was found between the oral and the anal intestine, and the end-to-end anastomosis was difficult. Therefore, a diamond-shaped anastomosis was performed using 5-0 polyglycolic acid sutures by incising the dilated oral tract in the minor axis and the anal in the major axis. A trans-anastomotic tube was placed nasally beyond the anastomotic site. The postoperative course was uneventful. Therefore, the diamond-shaped anastomosis may be an option for apple-peel intestinal atresia. • Apple-peel intestinal atresia is a rare form of bowel atresia that affects approximately 1/50000 live births. • In recent years, primary anastomosis with proximal enteroplasty has been successfully performed in patients with apple-peel type congenital small intestinal atresia. • We report a case of apple-peel intestinal atresia that was treated with a diamond-shaped anastomosis to adjust the anastomosis size. • The diamond-shaped anastomosis may be an option for apple-peel intestinal atresia.

Is the Use of Transanastomotic Tube Beneficial in Pyloric Atresia?

Introduction: Congenital pyloric atresia (CPA) is a rare gastrointestinal system anomaly characterized by gastric outlet obstruction. This study evaluated patients operated for CPA in the past 15 years. The impact of use or non-use of transanastomotic feeding tubes (TATs) on the follow-up results was examined. Material and Method: Patients operated for CPA between 2005 and 2020 were evaluated. Further, cases in whom TATs were used and cases in whom TATs were not used were evaluated in two sub-groups. The impact of presence orabsence of TATs on postoperative follow-up results was examined. Results: In this study, a total of 12 patients consisting of 7 boys and 5 girls were evaluated. The mean birth week was 35.1 ± 2.4 (31-38) weeks and the mean birth weight was 2602.9 ± 599.6 (1680-3620) grams. The mean time of operation was postnatal 3.8 (1-10) days. Among the cases, 8 (66.7%) had type 1 atresia, and 4 (33.3%) had type 2 atresia. Heineke-Mikulicz pyloroplasty was performed on 9 (75%) cases, and gastroduodenostomy was performed on 3 (25%) cases. 4 (33.2%) patients had various additional anomalies. The patient with EB (8.3%) died due to sepsis in the early postoperative phase. In 8 cases (66.7%), intraoperative TAT placement was performed. In cases with TATs, the time to postoperative feeding and length of stay were statistically determined to be lower. Discussion: Pyloric atresia is a rare intestinal system obstruction. Comorbidity with congenital anomalies increases mortality. Intraoperative TAT insertion enables early enteral feeding. Keywors: Congenital pyloric atresia, gastrointestinal system, transanastomotic feeding tubes

Endoluminal vacuum-assisted therapy to treat rectal anastomotic leakage: A critical analysis.

Endoluminal vacuum-assisted therapy (EVT) has been introduced recently to treat colorectal anastomotic leaks in clinically stable non-peritonitic patients. Its application has been mainly reserved to low colorectal and colo-anal anastomoses. The main advantage of this new procedure is to ensure continuous drainage of the abscess cavity, to promote and to accelerate the formation of granulation tissue resulting in a reduction of the abscess cavity. The reported results are promising allowing a higher preservation of the anastomosis when compared to conventional treatments that include trans-anastomotic tube placement, percutaneous drainage, endoscopic clipping of the anastomotic defect or stent placement. Nevertheless, despite this procedure is gaining acceptance among the surgical community, indications, inclusion criteria and definitions of success are not yet standardized and extremely heterogeneous, making it difficult to reach definitive conclusions and to ascertain which are the real benefits of this new procedure. Moreover, long-term and functional results are poorly reported. The present review is focused on critically analyzing the theoretical benefits and risks of the procedure, short- and long-term functional results and future direction in the application of EVT.

Acid suppression duration does not alter anastomotic stricture rates after esophageal atresia with distal tracheoesophageal fistula repair: A prospective multi-institutional cohort study

IntroductionAnastomotic stricture is the most common complication after esophageal atresia (EA) repair. We sought to determine if postoperative acid suppression is associated with reduced stricture formation. MethodsA prospective, multi-institutional cohort study of infants undergoing primary EA repair from 2016 to 2020 was performed. Landmark analysis and multivariate Cox regression were used to explore if initial duration of acid suppression was associated with stricture formation at hospital discharge (DC), 3-, 6-, and 9-months postoperatively. ResultsOf 156 patients, 79 (51%) developed strictures and 60 (76%) strictures occurred within three months following repair. Acid suppression was used in 141 patients (90%). Landmark analysis showed acid suppression was not associated with reduction in initial stricture formation at DC, 3-, 6- and 9-months, respectively (p = 0.19–0.95). Multivariate regression demonstrated use of a transanastomotic tube was significantly associated with stricture formation at DC (Hazard Ratio (HR) = 2.21 (95% CI 1.24–3.95, p<0.01) and 3-months (HR 5.31, 95% CI 1.65–17.16, p<0.01). There was no association between acid suppression duration and stricture formation. ConclusionNo association between the duration of postoperative acid suppression and anastomotic stricture was observed. Transanastomotic tube use increased the risk of anastomotic strictures at hospital discharge and 3 months after repair. Level of Evidence2

Use of trans-anastomotic tubes in congenital duodenal obstruction

AimDespite data to suggest benefit of trans- anastomotic tube (TAT) feeding in infants following repair of congenital duodenal obstruction (CDO), TAT usage is limited. We aimed to report a large series of infants with CDO treated with or without TAT in order to improve the evidence underlying this simple intervention. MethodSingle centre retrospective review of all infants CDO over a 20-year period (January 1999 – November 2020, inclusive). Important outcomes were compared between infants treated with or without TAT. Data are median [IQR]. ResultsNinety-six infants were included. A TAT was placed in 54 infants (56%). Median time to full enteral feed was significantly shorter in the TAT group (6 [5–8] days vs 10 [7.5–12], p <0.001). Time to first feed was shorter in the TAT group (2 [2–2.8] days vs 3 [2–5], p<0.001). Significantly fewer infants with a TAT placed received a central venous catheter (CVC, 15% vs 76%, p <0.001). Infants without a TAT received parenteral nutrition (PN) for longer (0 [0–0] vs 7 [0–11] days, p <0.001). There was no change in length of stay between TAT and no TAT group (16 [13–21.8] vs 15 [12–21.8] days, p = 0.722). Eight infants (15%) in the TAT group required a CVC and PN. One infant in the TAT group developed a perforation that required surgical management and nine infants in the non-TAT group had complications related to the CVC (21%), including one infant that required general anaesthetic for tunnelled central line placement (2.3%). ConclusionIn infants with CDO, TAT use was associated with earlier establishment of full enteral feeds, reduced need for CVC and PN and reduced complications. Further research should focus on the barriers to wider use of TAT by surgeons and neonatologists in infants with CDO.Level III evidence

Role of Transanastomotic Feeding Tube versus Early Gastric Feeding in Postoperative Duodenal Surgery

Background: Postoperative enteral feeding in congenital duodenal obstruction is usually delayed due to dilated atonic duodenum. The trans-anastomotic tube feeding (TAT) has been proposed to be more effective than early gastric feeding in the role of supporting &ldquo;Enhanced recovery after surgery concept&rdquo;. Objective: Comparing time to feeding among patients using TAT, early gastric feeding, and traditional delayed gastric feeding. Materials and Methods: Comparing postoperative enteric feeding via TAT (group A: n=7) and gastric feeding (group B: n=6) &mdash; prospective data collected from 2015 to 2020 &mdash; to traditional gastric feeding (group C: n=17) that is retrospective data from 2008 to 2015, in neonates with congenital duodenal obstruction. Results: TAT and early gastric (OG) feedings had provided earlier enteral feeding compared to traditional practice (p&lt;0.001). The early gastric feeding was faster full fed than TAT on the earlier postoperative date with median (IQR) = 11 (10, 11) and 16 (13, 23) respectively. However, all 3 groups had the same timing of gastric full feeding (median (IQR): A=8 (5, 11); B=7 (4, 7); C=9 (5, 10)), p=0.772. Even not significant, the early gastric feeding group provided the shorter time of hospital stay and TPN administration. Conclusion: The early OG feeding is feasible for early postoperative feeding comparable to TAT feeding and applicable in cases beware of TAT-related complications. Postoperative gastric function recovery is not related to the pre- or post-anastomotic feeding. Keywords: Duodenal atresia; Duodenal stenosis; Neonatal duodenal obstruction; Trans-anastomotic feeding tube; Enteral feeding; ERAS

Is postoperative transanastomotic feeding beneficial in neonates with congenital duodenal obstruction?

PurposeWe aimed to evaluate possible positive and negative effects of postoperative use of transanastomotic feeding tube (TAFT) in neonates operated for congenital duodenal obstruction (CDO).MethodsThis is a retrospective study reviewing medical records of neonates operated for CDO during 2003–2020 and comparing postoperative feeding outcomes and complications in patients with and without TAFT. Approval from the hospital’s data protection officer was obtained.ResultsOne hundred patients, 59% girls, were included, and 37% received TAFT. Mean birth weight and gestational age were 2628 (675.1) grams and 36.6 (2.4) weeks, respectively. Furthermore, 45% had no other malformations, and 36% had Down syndrome. Patient demographics were similar for TAFT and not-TAFT patients, except that not-TAFT neonates weighed median 335 g less (p = 0.013). The TAFT group got parenteral nutrition 2 days shorter (p < 0.001) and started enteral feeds 1.5 days earlier (p < 0.001) than the not-TAFT group. Fewer neonates with TAFT got a central venous catheter [65 vs 89%, (p = 0.008)]. In the TAFT group, 67% were breast fed at discharge compared to 49% in the not-TAFT group (p = 0.096).ConclusionNeonates with TAFT had earlier first enteral feed, fewer days with parenteral nutrition and fewer placements of central venous catheters.

Diagnostic and therapeutic management algorithm for biliary complications in living liver donors.

This study aimed to demonstrate the efficacy of our diagnostic and therapeutic management algorithm and catheter-assisted (percutaneous transhepatic biliary tract drainage [PTBD] or transanastomotic feeding tube) hepaticojejunostomy (HJ) procedures in living liver donors (LLDs) with biliary complications. Living donor hepatectomy (LDH) was performed between September 2005 and April 2021 in 2 489 LLDs. Biliary complications developed in 220 LLDs (8.8%), 136 of which were male, and the median age was 29 (interquartile range [IQR]: 12) years. Endoscopic sphincterotomy ± stenting was performed in 132 LLDs, which was unsuccessful in 9 LLDs and required HJ. Overall, 142 LLDs underwent interventional radiologic procedures. Fifteen LLDs with biliary complications underwent HJ (PTBD catheter = 6 and transanastomotic feeding tube = 9) at a median of 44 days (IQR: 82). Following HJ, 14 LLDs did not have any complications throughout the median follow-up period of 1619 days (IQR: 1454). However, percutaneous dilation for HJ anastomotic stricture was performed in one patient. Biliary complications are very common following LDH; therefore, surgeons in the field should have a low threshold to perform HJ for biliary complications that persist after other treatments. Our catheter-assisted HJ techniques demonstrated a high success rate and aided HJ in a hostile abdomen during revisional surgery.

Risk factors for short-term complications graded by Clavien-Dindo after transanal endorectal pull-through in patients with Hirschsprung disease

Transanal endorectal pull-through (TERPT) is a common surgical procedure in Hirschsprung disease (HD). Aim of this study was to gain insight in the prevalence and severity of postoperative complications within 30-days after TERPT and to identify patient and perioperative characteristics, associated with the development of short-term postoperative complications. This study retrospectively analyzed data of children with HD and treated with TERPT in our center between 2005 and 2020. Complications emerging within 30-days after surgery were assessed using Clavien-Dindo (CD). Patient and perioperative characteristic as predictor of a complication were tested using (multivariable) logistic regression analysis. Twenty-two of 106 (21%) included patients (17 transanal only; 77 laparoscopic-assisted; 12 laparotomy-assisted) developed 35 complications, including two patients (1.8%) that deceased. We suspect postoperative rectal irrigation leading to perforation as cause of death in both patients. Six patients (6%) had a minor (CD<3) and 16 patients (15%) a major (CD≥3) complication. Anastomotic leakage (n=4, 11%), abdominal abscess (n=3, 9%) and anastomotic stricture (n=3,9%) occurred most frequently. Predictive factors for developing a complication were older age at time of surgery (OR 1.03 1.00-1.01, p=0.041), laparotomy-assisted surgery (OR 12.65, CI 1.712-93.07, p=0.013) and long-segment HD (OR 4.09 CI 1.09-15.39, p=0.037). We found a CD-graded short-term postoperative complication rate of 21% following TERPT, reporting anastomotic complications most frequently. In patients at risk a diverting stoma should be considered. We suspect postoperative rectal irrigation being the cause of two lethal perforations. Therefore, we recommend to place a rectal transanastomotic tube in all patients receiving TERPT. Level III.

Trans-anastomotic tube feeding in the management of congenital duodenal obstruction: a systematic review and meta-analysis.

Feed intolerance is a common problem in neonates with congenital duodenal obstruction (CDO). Some surgeons insert trans-anastomotic tubes (TAT) to facilitate feed tolerance. We conducted a systematic review to evaluate the efficacy and safety of TATs in CDO. Medline, EmBase, CINAHL, and Cochrane Library were searched till July 2020. Risk of bias was assessed using ROBINS-I tool. Meta-analysis was conducted using Random Effects Model. No randomized controlled trials addressing the question were identified. In the 6 included observational studies, 96 infants underwent intraoperative TAT placement and 117 did not. Four studies reported benefits of TAT such as early attainment of full feeds and decreased need for parenteral nutrition. Two studies reported better outcomes in the no-TAT group. Accidental removal of TAT without clinical harm was reported in three studies [5/37 (14%), 4/17 (23%), and 2/4 (50%)]. Overall meta-analysis found no differences between the groups on any outcome. However, sensitivity analysis after excluding two studies with high risk of bias found that TAT tubes are associated with shorter duration of PN and shorter time to full enteral feeds. GRADE of evidence was very low for all outcomes. Evidence is limited regarding the efficacy and safety of intraoperative TAT placement in neonates with CDO. Well-designed RCTs are needed to address the issue definitively.

How can we improve perinatal care in isolated multiple intestinal atresia? A retrospective study with a 30-year literature review

IntroductionMultiple intestinal atresia (MIA) is a rare cause of neonatal intestinal obstruction. To provide an overview of the current prenatal, surgical, and nutritional management of MIA, we report our experience and a literature review of papers published after 1990. MethodsAll cases of isolated MIA (non-hereditary, not associated with apple-peel syndrome or gastroschisis) treated at our institution between 2005 and 2016 were reviewed and compared with cases found in the literature. ResultsSeven patients were prenatally suspected of having intestinal obstruction and were postnatally diagnosed with MIA, with a mean 1.7 (1–2) resections–anastomoses (RA) and 6 (1–10) strictureplasties performed, resulting in a mean resected bowel length of 15.1cm (15–25 cm). Median time to full oral feed was 46 days (14–626 days). All patients were alive and none had orality disorder after a mean follow-up of 3.1 years (0.2–8.1 years). Three surgical strategies were found in the literature review: multiple RA (68%, 34/50) including Santulli's technique in four of 34 (12%) and anastomoses over a transanastomotic tube (32%, 16/50), with a 98% survival rate, and short-bowel syndrome for only two patients. ConclusionBowel-sparing surgery and appropriate medical management are key to ensuring a favorable nutritional and gastrointestinal outcome and a good prognosis. Prenatal assessment and standardization of the surgical course of treatment remain challenging.

Transanastomotic Feeding Tube In Surgical Management of Congenital Duodenal Obstruction: Case Series

Introduction. Prolonged fasting is a major concern in the postoperative management of congenital duodenal obstruction. Massive dilatation of the proximal segment would lead to diameter discrepancy and lack of propulsion, thus delaying enteral feeding. A transanastomotic feeding tube is an option to deliver early enteral feeding after surgical correction. The study evaluates the effectiveness and safety of a transanastomotic feeding tubes in the surgical management of congenital duodenal obstruction.