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.
Anatomically, CDO is subdevided into CCDO and ICDO. The clinical observation shows that outcomes between patients with CCDO and ICDO differ substantially.
The objective of this study was to analysis 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) and ICDO (n = 23).
CCDO was associated with a significantly higher prenatal ultrasonographic detection rate, lower gestational age at birth, lower age and weight at operation, higher rate of associated congenital heart disease, more extensive preoperative radiologic diagnostics, higher morbidity according to Clavien-Dindo classification and comprehensive complication index. The subgroup analysis of patients without congenital heart disease (CHD) and prematurity showed a longer time from operation to the initiation of enteral feeds in the CCDO group.
This study showed that CCDO and ICDO differ with regard to prenatal detection rate, preoperative diagnostics, postoperative enteral feeds, length of hospital stay and morbidity according to the Clavien-Dindo classification and the comprehensive complication index. The degree of CDO in mature patients without CHD influences the postoperative initiation of enteral feeding.
Efforts should to be undertaken to improve pre- and postnatal detection of ICDO in order to reduce preoperative morbidity and the delay to operative repair.