Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3787
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
Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes.
To quantify and compare the association between CCDO and ICDO with outcome parameters.
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).
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).
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.
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.