1
|
Yang SS, Lv C, Huang S, Tou JF, Lai DM. Retrospective assessment of short-term outcomes of robotic- versus laparoscopic-assisted duodenal diamond anastomosis in neonates. Surg Endosc 2024; 38:5214-5219. [PMID: 39046493 PMCID: PMC11362482 DOI: 10.1007/s00464-024-11070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE The purpose of this study was to retrospectively compare the short-term outcomes of robotic- (RAD) and laparoscopic-assisted duodenal diamond-shaped anastomosis (LAD) in neonates. METHODS Neonates who underwent RAD (n = 30) or LAD (n = 38) between January 2019 and December 2022 were analyzed retrospectively. Major patient data were collected, including preoperative, intraoperative, and postoperative information. RESULTS All patients were neonates below the age of 30 days weighing 4 kg. Thirty (44.1%) neonates underwent RAD and 38 neonates (55.9%) underwent LAD. Compared to the LAD group, the RAD group had a shorter intra-abdominal operation time (RAD, 60.0(50.0 ~ 70.0) min; LAD, 79.9(69.0 ~ 95.3) min; p < 0.001). There were no significant differences in immediate and 30-day complications between the two groups. CONCLUSIONS RAD is safe and effective in neonates. Compared to traditional LAD, RAD showed comparable results.
Collapse
Affiliation(s)
- Si-Si Yang
- Department of Neonatal Surgery, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Rd, Hangzhou, Zhejiang, China
| | - Chengjie Lv
- Department of Neonatal Surgery, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Rd, Hangzhou, Zhejiang, China
| | - Shoujiang Huang
- Department of Neonatal Surgery, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Rd, Hangzhou, Zhejiang, China
| | - Jin-Fa Tou
- Department of Neonatal Surgery, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Rd, Hangzhou, Zhejiang, China.
| | - Deng-Ming Lai
- Department of Neonatal Surgery, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Rd, Hangzhou, Zhejiang, China.
| |
Collapse
|
2
|
Zhang X, Xiang L, Qiu T, Zhou J, Che G, Ji Y, Xu Z. Laparoscopic Ladd's procedure for intestinal malrotation in small infants with midterm follow-up. BMC Gastroenterol 2023; 23:402. [PMID: 37986145 PMCID: PMC10659069 DOI: 10.1186/s12876-023-03046-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The objective of this study was to evaluate the safety and efficacy of laparoscopic Ladd's procedure (LL) for intestinal malrotation (IM) in small infants. METHODS All patients aged < 6 months with IM who underwent Ladd's procedures between January 2012 and December 2019 were enrolled. The perioperative demographics and midterm follow-up results were retrospectively reviewed and compared between patients who underwent LL and open Ladd's operation (OL). RESULTS Fifty-five patients were enrolled for analysis. The baseline characteristics were well matched in the two groups. The rate of volvulus was similar in the two groups (76.2% vs. 73.5%, P = 0.81). Two cases in the LL group were converted to OL due to intraoperative bleeding and intestinal swelling. The operative time (ORT) was not significantly different between the two groups (73.8 ± 18.7 vs. 66.8 ± 11.6 min, P = 0.76). Compared to the OL group, the LL group had a shorter time full feed (TFF) (3.1 ± 1.2 vs. 7.3 ± 1.9 days, P = 0.03) and a shorter postoperative hospital stay (PHS) than the OL group (5.5 ± 1.6 vs. 11.3 ± 2.7 days, P = 0.02). The rate of postoperative complications was similar in the two groups (9.5% vs. 11.8%, P = 0.47). The LL group had a lower rate of adhesive obstruction than the OL group, but the difference was not significant (0.0% vs. 11.8%, P = 0.09). One patient suffered recurrence in the LL group, while 0 patients suffered recurrence in the OL group (4.8% vs. 0.0%, P = 0.07). The rate of reoperation in the two groups was similar (4.8% vs. 8.8%). CONCLUSIONS The LL procedure for IM in small infants was a safe and reliable method that had a satisfactory cosmetic appearance and shorter TFF and PHS than OL.
Collapse
Affiliation(s)
- Xuepeng Zhang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lvna Xiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tong Qiu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiangyuan Zhou
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yi Ji
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Zhicheng Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
3
|
Li S, Jin Y, Zhao Y, Huang J. Development of a Modified Duodenum Traction Technique in Laparoscopic Duodenal Web Excision. J Laparoendosc Adv Surg Tech A 2023; 33:909-913. [PMID: 37256714 DOI: 10.1089/lap.2022.0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Introduction: Laparoscopic duodenal web resection surgery remains safe in neonates. The pearls in laparoscopic duodenal web excision are a proper and stable duodenal exposure. Herein, we present a modified duodenal traction technique, which can improve operative field exposure in laparoscopic surgery. Material and Methods: This modified technique was performed in 54 patients during laparoscopic duodenal web resection surgery at our center. It was performed using a 5-0 PDS-II suture, which was introduced percutaneously at 1-2 cm under either side of the costal margin at the anterior axillary line, respectively, to retract the duodenum. Results: Perioperative data of these patients and short-term follow-up data of duodenal web patients were retrospectively reviewed. All 54 procedures were completed without conversion to open surgery or requiring additional ports. Patients' mean age at surgery was 5 days (range 2-30 days), and the median weight at the time of surgery was 3.25 kg (range 2.52-3.88 kg). Eight patients (14.8%) had complete membranes, whereas 46 (85.2%) had a membrane with a hole. The mean time required for this technique was 336 (range 216-416) seconds and the mean duration of the entire surgery was 77 (range 65-89) minutes. The mean postoperative hospital stay was 16 (range 9-90) days and no postoperative complication related to the suspension procedure occurred. Conclusion: Our outcomes demonstrated the modified duodenal traction technique is a feasible and ideal method during laparoscopic duodenal web resection surgery.
Collapse
Affiliation(s)
- Shuangshuang Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuyan Jin
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yong Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| |
Collapse
|
4
|
Pijpers AGH, Eeftinck Schattenkerk LD, de Vries R, Broers CJM, Straver B, van Heurn ELW, Musters GD, Gorter RR, Derikx JPM. Cardiac anomalies in children with congenital duodenal obstruction: a systematic review with meta-analysis. Pediatr Surg Int 2023; 39:160. [PMID: 36967411 PMCID: PMC10040397 DOI: 10.1007/s00383-023-05449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Cardiac anomalies occur frequently in patients with congenital duodenal obstruction (DO). However, the exact occurrence and the type of associated anomalies remain unknown. Therefore, the aim of this systematic review is to aggregate the available literatures on cardiac anomalies in patients with DO. METHODS In July 2022, a search was performed in PubMed and Embase.com. Studies describing cardiac anomalies in patients with congenital DO were considered eligible. Primary outcome was the pooled percentage of cardiac anomalies in patients with DO. Secondary outcomes were the pooled percentages of the types of cardiac anomalies, type of DO, and trisomy 21. A meta-analysis was performed to pool the reported data. RESULTS In total, 99 publications met our eligibility data, representing 6725 patients. The pooled percentage of cardiac anomalies was 29% (95% CI 0.26-0.32). The most common cardiac anomalies were persistent foramen ovale 35% (95% CI 0.20-0.54), ventricular septal defect 33% (95% CI 0.24-0.43), and atrial septal defect 33% (95% CI 0.26-0.41). The most prevalent type of obstruction was type 3 (complete atresias), with a pooled percentage of 54% (95% CI 0.48-0.60). The pooled percentage of Trisomy 21 in patients with DO was 28% (95% CI 0.26-0.31). CONCLUSION This review shows cardiac anomalies are found in one-third of the patients with DO regardless of the presence of trisomy 21. Therefore, we recommend that patients with DO should receive preoperative cardiac screening. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Adinda G H Pijpers
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands.
| | - Laurens D Eeftinck Schattenkerk
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Chantal J M Broers
- Department of Pediatrics, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Bart Straver
- Department of Pediatric Cardiology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ernest L W van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
| | - Gijsbert D Musters
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Zhang J, Xu X, Wang X, Zhao L, Lv Y, Chen K. Laparoscopic versus open repair of congenital duodenal obstruction: a systematic review and meta-analysis. Pediatr Surg Int 2022; 38:1507-1515. [PMID: 36053328 DOI: 10.1007/s00383-022-05209-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the safety and efficacy of laparoscopic versus open repair of congenital duodenal obstruction (CDO), we conducted a systematic review and meta-analysis (CDO). METHODS A literature search was conducted to identify studies that compared laparoscopic surgery (LS) and open surgery (OS) for neonates with CDO. Meta-analysis was used to pool and compare variables such as operative time, time to feeding, length of hospital stay, anastomotic leak or stricture, postoperative ileus, wound infection, and overall postoperative complications. RESULTS Among the 1348 neonatal participants with CDO in the ten studies, 304 received LS and 1044 received OS. When compared to the OS approach, the LS approach resulted in shorter hospital stays, faster time to initial and full feeding, longer operative time, and less wound infection. However, no significant difference in secondary outcomes such as anastomotic leak or stricture, postoperative ileus, and overall postoperative complications was found between LS and OS. CONCLUSIONS LS is a safe, feasible and effective surgical procedure for neonatal CDO when compared to OS. Compared with OS, LS has a faster time to feeding, a shorter hospital stay, and less wound infection. Furthermore, in terms of anastomotic leak or stricture, postoperative ileus, and overall postoperative complications, LS is equivalent to OS. We conclude that LS should be considered an acceptable option for CDO.
Collapse
Affiliation(s)
- Jie Zhang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Xiaoqi Xu
- Department of Pediatrics, The Fourth Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, China
| | - Xiaoman Wang
- Department of Pediatrics, The Fourth Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, China
| | - Lingling Zhao
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Yaxin Lv
- Department of Pediatrics, The Fourth Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, China
| | - Kuai Chen
- Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
| |
Collapse
|
6
|
Laparoscopic treatment of annular pancreas in a neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
7
|
Laparoscopic versus open surgery for the repair of congenital duodenal obstructions in infants and children. Surg Endosc 2018; 32:3909-3917. [PMID: 29484555 DOI: 10.1007/s00464-018-6130-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 02/23/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Laparoscopic repair of congenital duodenal obstruction (LCDO) was described more than 15 years ago. However, studies comparing outcomes of LCDO with open repair (OCDO) are rare. Standardized assessments of complications using the Clavien-Dindo classification (CDC) and the comprehensive complication index (CCI) are not available. METHODS All patients undergoing OCDO or LCDO between 2004 and 2017 were identified from the institutional database by retrospective analysis. Postoperative outcomes were assessed, including all complications using the CDC and the CCI. RESULTS Forty-seven consecutive patients were identified; 27 patients underwent LCDO and 20 patients had OCDO. Both groups did not differ regarding demographics, associated congenital anomalies, intraoperative pathologic findings, and operative procedures. LCDO was associated with a longer operative time [mean (SD), 202 (89) vs. 112 (41) min, P < 0.0001], shorter time to initiation of feeds [median (range), 1 (0-4) vs. 3 (1-12) days, P = 0.0027], and shorter time to full feeds [mean (SD), 8.2 (4.1) vs. 12.2 (6.4) days, P = 0.0243] compared to OCDO. Shorter length of postoperative hospital stay in LCDO group was achieved for patients without cardiac anomalies [mean (SD), 9.4 (3.1) days in LCDO group vs. 17.2 (9.4) days in OCDO, P = 0.0396] and patients without other anomalies [median (range), 12 (3-38) days in LCDO group vs. 21 (7-31) days in OCDO, P = 0.0460]. LCDO was associated with a lower CCI [median (range) 0 (0-39.7) vs. 4.3 (0-100), P = 0.0270]. CONCLUSIONS Despite a longer operative time for LCDO, a number of advantages of LCDO over OCDO were recognized comparing both approaches in the repair of congenital duodenal obstruction. Such advantages include a lower morbidity, reduced time to initiation and completion of full enteral feeds, and shorter length of postoperative hospitalization for patients without concomitant cardiac anomalies and for patients without other anomalies when operated laparoscopic. In view of the present results, LCDO, performed in selected patients, appears to represent a viable alternative to OCDO.
Collapse
|
8
|
Mentessidou A, Saxena AK. Laparoscopic Repair of Duodenal Atresia: Systematic Review and Meta-Analysis. World J Surg 2018; 41:2178-2184. [PMID: 28258456 DOI: 10.1007/s00268-017-3937-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the outcome of laparoscopic repair of duodenal atresia (LRDA) in relation to different approaches with regard to suture material and anastomosis technique. To identify evidence for the safety and efficacy of LRDA compared with the conventional open repair. METHODS Systematic search was performed for all studies on LRDA, excluding case reports, and all comparative studies between LRDA and open repair. Chi-square was used to assess associations between complications or conversions rates and different LRDA approaches (suture material, suturing technique). Meta-analysis was employed to compare LRDA and open repair. RESULTS The complications and conversions rates of LRDA were not affected by the different suture materials (Silk, Vicryl, PDS; p = 0.51) or suturing technique (interrupted, continuous; p = 0.46). The meta-analysis did not show significant differences between LRDA and open repair in overall complications rate (p = 0.88), time to feeds (p = 0.12) and hospitalization time (p = 0.28), although it revealed longer operative time with LRDA (p < 0.0001). CONCLUSIONS LRDA shows comparable safety and efficacy with the open repair, although it is associated with significantly longer operative time. There is no evidence that the type of the suture material or anastomotic technique affects the outcome of LRDA.
Collapse
Affiliation(s)
- Anastasia Mentessidou
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College, London, UK
| | - Amulya K Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College, London, UK.
| |
Collapse
|
9
|
Huntington JT, Lopez JJ, Mahida JB, Ambeba EJ, Asti L, Deans KJ, Minneci PC. Comparing laparoscopic versus open Ladd's procedure in pediatric patients. J Pediatr Surg 2017; 52:1128-1131. [PMID: 27856011 DOI: 10.1016/j.jpedsurg.2016.10.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/28/2016] [Accepted: 10/15/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND/PURPOSE The objective of this study was to perform a comparative analysis of laparoscopic versus open Ladd's procedure on 30-day postoperative outcomes. METHODS All elective Ladd's procedures performed on patients with intestinal malrotation in the 2013-2014 National Surgical Quality Improvement Program Pediatric were identified. A propensity score-matched analysis was used to account for baseline differences between groups, and generalized estimating equations (GEEs) were used to compare 30-day outcomes between open versus laparoscopic groups. RESULTS Fifty-eight (18.6%) patients underwent laparoscopic Ladd's while 253 (81.4%) underwent an open technique. After propensity score matching, 53 laparoscopic cases (38.1%) and 86 open cases (61.9%) were identified and compared for outcomes. Total length of stay was shorter for the laparoscopic group compared to the open group (6 vs. 4days, p<0.001). Postoperative length of stay was shorter for the laparoscopic group as well (5 vs. 4days, p<0.001). Postoperative complications occurred in 5 laparoscopic cases (9.4%) and in 18 open cases (20.9%), but did not meet statistical significance (p=0.08). One laparoscopic patient (1.9%) and 8 open patients (9.3%) required hospitalization beyond 30days, but this also did not meet significance (p=0.08). CONCLUSIONS In a matched analysis, laparoscopic Ladd's led to shorter hospital stays than open Ladd's in the initial 30-day postoperative period. Short-term benefits of laparoscopic Ladd's lend support for using additional resources to perform multi-institutional studies to compare differences in long-term outcomes between laparoscopic and open Ladd's. TYPE OF STUDY Therapeutic LEVEL OF EVIDENCE: III.
Collapse
Affiliation(s)
- Justin T Huntington
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Joseph J Lopez
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Justin B Mahida
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Erica J Ambeba
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Lindsey Asti
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Peter C Minneci
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
| |
Collapse
|
10
|
Chung PHY, Wong CWY, Ip DKM, Tam PKH, Wong KKY. Is laparoscopic surgery better than open surgery for the repair of congenital duodenal obstruction? A review of the current evidences. J Pediatr Surg 2017; 52:498-503. [PMID: 27622585 DOI: 10.1016/j.jpedsurg.2016.08.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/11/2016] [Accepted: 08/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Whether laparoscopic surgery is superior to open surgery in the repair of congenital duodenal obstruction remains controversial. The objective of this study is to systematically review the literatures, which compare the outcomes of these two operative approaches. METHODS A systematic review of the studies comparing these two surgical approaches since 2000 was carried out. RESULTS Four retrospective cohort studies comprising 180 patients were eligible for analysis. Duodenal atresia was the most common diagnosis (62.3%). Overall, there were no statistically significant differences in terms of operative duration (SMD: 0.75, 95% CI: 0.46-1.04), ventilator dependence (SMD: 0.04, 95% CI: -0.22 to 0.29), time to initial enteral feeding (SMD: 0.12, 95% CI: -0.14 to 0.38), time to full enteral feeding (SMD: 0.18, 95% CI: -0.15 to 0.50) and hospital stay (SMD: -0.03, 95% CI: -0.29 to 0.22). The overall incidences of anastomotic complications in laparoscopic vs open groups were 4.4% vs 1.8%. Two cases of missed distal pathology were reported in the laparoscopic group. CONCLUSIONS Laparoscopic surgery is feasible in the repair of CDO. Study with larger sample size is needed for further analysis to examine whether open or laparoscopic approach is superior. Meanwhile, it is still safe to practice laparoscopic repair of CDO in skilled surgeons, with attention to the possibility of distal pathology.
Collapse
Affiliation(s)
- Patrick Ho Yu Chung
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Carol Wing Yan Wong
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Dennis Kai Ming Ip
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Paul Kwong Hang Tam
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Kenneth Kak Yuen Wong
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong.
| |
Collapse
|
11
|
Cho MJ, Kim DY, Kim SC, Namgoong JM. Transition from Laparotomy to Laparoscopic Repair of Congenital Duodenal Obstruction in Neonates: Our Early Experience. Front Pediatr 2017; 5:203. [PMID: 29018788 PMCID: PMC5614921 DOI: 10.3389/fped.2017.00203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/05/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this report was to review our early experience of the last 7 years with repairs of congenital duodenal obstruction (CDO) to determine the efficacy and outcomes of laparoscopic repairs compared to laparotomy. METHODS A retrospective review was conducted on all neonate (<30 days) with CDO between 2009 and 2015. Patients with duodenal atresia, stenosis, web, and annular pancreas were included. Patients with only malrotation or delayed presentation were excluded. RESULTS Twenty-six neonates underwent laparoscopy and 30 underwent traditional laparotomy. The operative time was longer in the laparoscopic group (P = 0.001), but time to initiation of feeds and time to full feeds were similar for the laparoscopic and open groups. There was no mortality, anastomosis leakage, or stenosis in the laparoscopic group. Six laparoscopic cases required conversion to an open procedure (23%). In the earlier cases, the open conversion rate was high, but it decreased over time (P = 0.003). CONCLUSION Laparoscopic repair is safe and effective for repair of CDO in neonates. Despite operative time was slightly longer in the laparoscopic group, clinical outcomes remained similar to the open group. For pediatric surgeon with experience in laparoscopic techniques, laparoscopic duodenoduodenostomy is a sufficient available procedure.
Collapse
Affiliation(s)
- Min Jeng Cho
- Department of Surgery, Ulsan University Hospital, Ulsan, South Korea
| | - Dae Yeon Kim
- Division of Pediatric Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seong Chul Kim
- Division of Pediatric Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jung Man Namgoong
- Division of Pediatric Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| |
Collapse
|
12
|
Oh C, Lee S, Lee SK, Seo JM. Laparoscopic duodenoduodenostomy with parallel anastomosis for duodenal atresia. Surg Endosc 2016; 31:2406-2410. [PMID: 27655378 DOI: 10.1007/s00464-016-5241-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 09/06/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Currently, a diamond-shaped anastomosis is preferred for the surgical repair of duodenal atresia (DA) in both open and laparoscopic surgery. We report the results of laparoscopic duodenoduodenostomy with parallel anastomosis (LDPA) in DA. METHODS We retrospectively reviewed 22 patients who underwent laparoscopic duodenoduodenostomy from February 2005 to May 2015 in Samsung Medical Center. All patients underwent operation within the first month after birth. Patients who were transversely anastomosed after duodenotomy and patients who underwent simultaneous operation on combined anomalies were excluded. Parallel anastomosis was used in all surgeries. Four trocars were used in laparoscopic repair. After mobilization of both proximal and distal ends, the proximal end was incised transversely and the distal end was incised longitudinally. Duodenoduodenostomy with parallel anastomosis using a 5-0 glyconate monofilament was performed with interrupted sutures. RESULTS Eleven patients (50 %) were male. Median gestational age was 36 + 6 weeks (32 + 7-40 + 6). Median age at the time of operation and median body weight were 3 days (1-12) and 2.53 kg (1.63-3.18), respectively. All patients were diagnosed prenatally and 16 patients (72.7 %) had associated anomalies. Median operation time was 142 min (96-290) and median postoperative day to start oral feeding was 5 days (3-9) and median postoperative day of reaching full feeding was 11 days (6-19). Median postoperative day was 13 days (10-60). There was no anastomotic leakage or stenosis. Median follow up was 3.5 months (1-21). Currently, there is no late complication. CONCLUSIONS LDPA can be performed easily to patients who have DA in neonatal period. It is anatomically natural and the risk of leakage or stenosis does not seem significant. Therefore, parallel anastomosis should be considered as a safe procedural option for laparoscopic duodenoduodenostomy in DA.
Collapse
Affiliation(s)
- Chaeyoun Oh
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghoon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Suk-Koo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jeong-Meen Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
| |
Collapse
|
13
|
Laparoscopic management of congenital duodenal atresia or stenosis: A single-center early experience. J Pediatr Surg 2015; 50:1833-6. [PMID: 26093906 DOI: 10.1016/j.jpedsurg.2015.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 04/29/2015] [Accepted: 05/22/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The background is to review our experience with laparoscopic repair of congenital duodenal atresia or stenosis (CDAS) and compare postoperative outcome with a group control of laparotomy repair. METHODS Retrospective chart review of all cases of CDAS undergoing laparoscopic surgery at our institution between July 2013 and May 2014 and comparison with a group control of open operation performed between 2007 and 2010. Data were compared using Fisher's exact test for qualitative values and Mann-Whitney test for quantitative values. P values less than 0,05 were considered statistically significant. RESULTS Ten consecutive cases were identified in laparoscopic group (7 duodenoduodenostomy and 3 duodenojejunostomy) and 19 cases in laparotomy group (16 duodenoduodenostomy and 3 web excision). Median birth weight was lower in laparoscopic group (2125 grams Vs 2777 grams p=0,04). In laparoscopic group, there was no conversion and no intraoperative complication. Median duration of surgery was 90minutes (80-150). In both groups, the surgical morbidity rate was 10%. Median time to initiation of oral feeding was significatively shorter in laparotomy group (8days Vs 4 p=0,009). Median time to full oral feeding and length of stay were shorter in laparotomy but not statistically different. (36days Vs 16,5 p=0,14 and 45,5days Vs 25,5 p=0,09 respectively) After a median follow up of 149,5days (24-355) in laparoscopic group, 8 children had a full oral intake. Five children had a weight below the 10th percentile. CONCLUSION The laparoscopic approach for CDAS is safe and reproducible with outcomes similar to open repair even in the beginning of a learning curve for pediatric surgeons with appropriate laparoscopic skills. In this small series, laparoscopy did not appear to decrease time to full oral intake or length of stay. Larger studies are suggested to provide more conclusive results.
Collapse
|
14
|
Chandrasekharam V. Laparoscopic duodenoduodenostomy in neonates: Report of two cases and review of the literature. J Indian Assoc Pediatr Surg 2015; 20:150-2. [PMID: 26166989 PMCID: PMC4481630 DOI: 10.4103/0971-9261.154666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Congenital duodenal obstruction is traditionally managed by laparotomy. Laparoscopic duodenoduodenostomy (LDD) in neonates is considered a technically demanding operation requiring advanced pediatric laparoscopic skills. To the best of our knowledge, there are no reports of LDD from the Indian subcontinent. Here, we report two cases of successful LDD in neonates and review the relevant literature.
Collapse
Affiliation(s)
- Vvs Chandrasekharam
- Department of Pediatric Surgery, Pediatric Urology and MAS, Rainbow Children's Hospitals, Hyderabad, Telangana, India
| |
Collapse
|
15
|
Duodenal web resection via hybrid natural orifice transluminal endoscopic surgery (NOTES). JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
16
|
Chen QJ, Gao ZG, Tou JF, Qian YZ, Li MJ, Xiong QX, Shu Q. Congenital duodenal obstruction in neonates: a decade's experience from one center. World J Pediatr 2014; 10:238-44. [PMID: 25124975 DOI: 10.1007/s12519-014-0499-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 07/10/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Congenital duodenal obstruction (CDO) is one of the most common anomalies in newborns, and accounting for nearly half of all cases of neonatal intestinal obstruction. This study aimed to review our single-center experience in managing congenital duodenal obstruction while evaluate the outcomes. METHODS We conducted a retrospective analysis of the records of all neonates dianogsed with congenital duodenal obstruction admitted to our center between January 2003 and December 2012. We analyzed demographic criteria, clinical manifestations, associated anomalies, radiologic findings, surgical methods, postoperative complications, and final outcomes. RESULTS The study comprised 287 newborns (193 boys and 94 girls). Birth weight ranged from 950 g to 4850 g. Fifty-three patients were born prematurely between 28 and 36 weeks' gestation. Malrotation was diagnosed in 174 patients, annular pancreas in 66, duodenal web in 55, duodenal atresia or stenosis in 9, preduodenal portal vein in 2, and congenital band compression in 1. Twenty patients had various combinations of these conditions. Presenting symptoms included bilious vomiting, dehydration, and weight loss. X-rays of the upper abdomen demonstrated the presence of a typical double-bubble sign or air-fluid levels in 68.64% of patients, and confirmatory upper and/or lower gastrointestinal contrast studies were obtained in 64.11%. Multiple associated abnormalities were observed in 50.52% of the patients. Various surgical approaches were used, including Ladd's procedure, duodenoplasty, duodenoduodenostomy, duodenojejunostomy, or a combination of these. Seventeen patients died postoperatively and 14 required re-operation. CONCLUSIONS Congenital duodenal obstruction is a complex entity with various etiologies and often includes multiple concomitant disorders. Timely diagnosis and aggressive surgery are key to improving prognosis. Care should be taken to address all of the causes of duodenal obstruction and/or associated alimentary tract anomalies during surgery.
Collapse
Affiliation(s)
- Qing-Jiang Chen
- Department of Pediatric General Surgery, Children's Hospital, Zhejiang University Shool of Medicine, Hangzhou, 310003, China
| | | | | | | | | | | | | |
Collapse
|
17
|
Jensen AR, Short SS, Anselmo DM, Torres MB, Frykman PK, Shin CE, Wang K, Nguyen NX. Laparoscopic versus open treatment of congenital duodenal obstruction: multicenter short-term outcomes analysis. J Laparoendosc Adv Surg Tech A 2014; 23:876-80. [PMID: 24079961 DOI: 10.1089/lap.2013.0140] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laparoscopic repair of congenital duodenal obstruction has become popularized over the past decade. Comparative data on outcomes, however, are sparse. We hypothesized that laparoscopic repair of congenital duodenal obstruction could be performed with similar outcomes to traditional open repair. PATIENTS AND METHODS Medical records for all cases of congenital duodenal obstruction from 2005 to 2011 at three academic teaching hospitals were retrospectively reviewed. Patients were excluded from the analysis if they had confounding surgical diseases, did not have duodenoduodenostomy during the first hospital admission, had the repair performed before transfer from a referring hospital, or weighed less than 1.7 kg at the time of surgery. Analysis was performed as intention to treat, with laparoscopic converted to open cases included in the laparoscopic group. RESULTS Sixty-four cases were included in the analysis (44 open, 20 laparoscopic). Baseline characteristics were similar between the two groups with the exception that the open group, on average, underwent repair later than the laparoscopic group (6 days versus 4 days, respectively). Seven laparoscopic cases were converted to an open procedure (35%), most commonly for difficulty in exposing the decompressed distal duodenum. Laparoscopic repair did take significantly longer than open repair (145 minutes versus 96 minutes, respectively), but clinical outcomes were similar. Complications were rare and were similar between methods of repair. Two patients in the laparoscopic group required subsequent open revision. CONCLUSIONS Laparoscopic duodenoduodenostomy for congenital duodenal obstruction is a technically challenging procedure with a steep learning curve. Despite a relatively high conversion rate, clinical outcomes remained similar to the traditional open repair in selected patients.
Collapse
Affiliation(s)
- Aaron R Jensen
- 1 Division of Pediatric Surgery, Children's Hospital Los Angeles , Los Angeles, California
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Li B, Chen WB, Zhou WY. Laparoscopic methods in the treatment of congenital duodenal obstruction for neonates. J Laparoendosc Adv Surg Tech A 2013; 23:881-4. [PMID: 23968252 DOI: 10.1089/lap.2013.0097] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of and indication for laparoscopic methods for neonates with congenital duodenal obstruction. PATIENTS AND METHODS From September 2009 to October 2012, 40 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 6-8 mm Hg and a suspending suture for the right liver elevator, the procedure was performed using four trocars 3-5 mm in diameter. Under laparoscopic vision, the causes of duodenal obstruction were diagnosed, and then the operation methods were determined by the type of obstruction. RESULTS Of the 40 cases, 4 were duodenal atresia (type II), 8 were duodenal stenosis, 8 were annular pancreas, and 20 were congenital intestinal malrotation. For the cases with duodenal diaphragmatic stenosis a partial excision of the diaphragm was performed after longitudinal incision of the anterior part of the duodenum followed laparoscopically by a transverse suture. For the cases with duodenal atresia (type II) and annular pancreas, a duodenal diamond anastomosis was successfully carried out through a laparoscopic approach. Ladd's operational method was performed in the cases with congenital intestinal malrotation. Feedings were started on postoperative Day 3-7, without abdominal distention and vomiting, and discharge from the the hospital was on postoperative Day 9-14. CONCLUSIONS Congenital duodenal obstruction is a common malformation in neonates. The laparoscopic procedure is an important method of diagnosing, and correct operational methods are the key to improve the therapeutic effect in the treatment of congenital duodenal obstruction. The laparoscope has the value of a small incision, microinvasion, and better recovery in diagnosis and treatment for congenital duodenal obstruction. The laparoscopic methods can be performed in neonates safely and are appropriate for a full-term newborn with tolerance to CO2 pneumoperitoneum.
Collapse
Affiliation(s)
- Bing Li
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital , Jiang Su, China
| | | | | |
Collapse
|