Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2019; 25(28): 3787-3797
Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3787
Comparison of outcomes between complete and incomplete congenital duodenal obstruction
Stefan Gfroerer, Till-Martin Theilen, Henning C Fiegel, Anoosh Esmaeili, Udo Rolle
Stefan Gfroerer, Till-Martin Theilen, Henning C Fiegel, Udo Rolle, Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Frankfurt 60590, Germany
Anoosh Esmaeili, Department of Pediatric Cardiology, University Hospital Frankfurt, Frankfurt 60590, Germany
Author contributions: Gfroerer S, Theilen TM, Esmaeili A, and Rolle U contributed to study conception and design, acquisition, analysis and interpretation of data, and final approval of the version of the article to be published; Gfroerer S drafted of the article; Theilen TM, Esmaeili A, and Rolle U contributed to critical revisions related to the important intellectual content of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the University Hospital Frankfurt.
Informed consent statement: Patients and parents were not required to give informed consent for the study because the analysis used anonymous data that were obtained after the completion of treatment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Stefan Gfroerer, MD, Surgeon, Deputy Head, Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany. stefan.gfroerer@kgu.de
Telephone: +49-69-63016659 Fax: +49-69-63017936
Received: March 29, 2019
Peer-review started: March 29, 2019
First decision: May 30, 2019
Revised: June 13, 2019
Accepted: July 5, 2019
Article in press: July 5, 2019
Published online: July 28, 2019
Abstract
BACKGROUND

Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes.

AIM

To quantify and compare the association between CCDO and ICDO with outcome parameters.

METHODS

We retrospectively reviewed all patients who underwent operative repair of CCDO or ICDO in our tertiary care institution between January 2004 and January 2017. The demographics, clinical presentation, preoperative diagnostics and postoperative outcomes of 50 patients were compared between CCDO (n = 27; atresia type 1-3, annular pancreas) and ICDO (n = 23; annular pancreas, web, Ladd´s bands).

RESULTS

In total, 50 patients who underwent CDO repair were enrolled and followed for a median of 5.2 and 3.9 years (CCDO and ICDO, resp.). CCDO was associated with a significantly higher prenatal ultrasonographic detection rate (88% versus 4%; CCDO vs ICDO, P < 0.01), lower gestational age at birth, lower age and weight at operation, higher rate of associated congenital heart disease (CHD), more extensive preoperative radiologic diagnostics, higher morbidity according to Clavien-Dindo classification and comprehensive complication index (all P ≤ 0.01). The subgroup analysis of patients without CHD and prematurity showed a longer time from operation to the initiation of enteral feeds in the CCDO group (P < 0.01).

CONCLUSION

CCDO and ICDO differ with regard to prenatal detection rate, gestational age, age and weight at operation, rate of associated CHD, preoperative diagnostics and morbidity. The degree of CDO in mature patients without CHD influences the postoperative initiation of enteral feeding.

Keywords: Congenital duodenal obstruction, Duodenal atresia, Duodenal stenosis, Prenatal ultrasonographic detection rate, Clinical presentation, Preoperative diagnostics, Adverse events, Outcome

Core tip: Outcomes of complete congenital duodenal obstruction (CCDO) and incomplete (ICDO) have rarely been compared. The present study is the first to report on this issue based on a series of patients who represent a broad spectrum of pathologies in either group. The current results show significant differences between CCDO and ICDO with regard to prenatal detection rate, preoperative diagnostics, postoperative enteral feeds, length of hospital stay and morbidity according to Clavien-Dindo classification and the comprehensive complication index.