Factors associated with outcomes in congenital duodenal obstruction: population-based study

Bethell, George; Long, Anna‐May; Knight, Marian; Hall, Nigel

doi:10.1093/bjs/znad040

Cited by 2 publications

(13 citation statements)

References 12 publications

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“…There were 12 studies 2–6 10–16 that met the inclusion criteria ( figure 1 ), all of which were observational. Of these, two were prospective 2 11 while the remainder were retrospective ( table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“… 1 Following repair, there is variation in the nutritional management of these infants. 2 Nutritional support is required since although continuity of the gastrointestinal tract has been surgically restored, there remains a functional obstruction due to many months of in-utero obstruction resulting in dilatation of the stomach and proximal duodenum, with gastroparesis. Existing data demonstrate that current nutritional management usually comprises provision of parenteral nutrition (PN), provision of enteral nutrition via a transanastomotic tube (TAT) or a combination of both.…”

Section: Introductionmentioning

confidence: 99%

“…Existing data demonstrate that current nutritional management usually comprises provision of parenteral nutrition (PN), provision of enteral nutrition via a transanastomotic tube (TAT) or a combination of both. 2 TAT insertion at time of CDO repair is an effective method of allowing provision of early enteral nutrition and carries several purported advantages that have prompted its uptake by some clinicians. These include reduced use of PN, associated reduced requirement for central venous access, earlier achievement of full enteral feeds and reduced cost.…”

Section: Introductionmentioning

confidence: 99%

“… 3–5 However, others prefer not to use a TAT for feeding, citing concerns about tube-related small bowel perforation 4 and pointing out that despite earlier achievement of full enteral feeds, TAT feeding does not reduce length of stay since this is dependent on recovery of gastric function and TAT feeding does not impact this. 2 6 …”

Section: Introductionmentioning

confidence: 99%

“…Recently, there have been further publications in this field including the first multicentre prospective study comparing outcomes of TAT versus no TAT placement in CDO and another large retrospective study addressing this research question. 2 5 Given this vast increase in cases reported over the previous 3 years, we aimed to provide an up-to-date comparison of outcomes of CDO repair with and without TAT feeding.…”

Section: Introductionmentioning

confidence: 99%

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

Bethell,

Neville,

Johnson

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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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 outcome measuresThe main outcome was time to full enteral feeds. Additional outcomes included use of parenteral nutrition (PN), cost and complications from either TAT or central venous catheter. Meta-analyses were undertaken using random-effects models (mean difference (MD) and risk difference (RD)), and risk of bias was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool.ResultsTwelve out of 373 articles screened met the inclusion criteria. All studies were observational and two were prospective. Nine studies, containing 469 infants, were available for meta-analysis; however, four were excluded due to serious or critical risk of bias. TAT feeding was associated with reduced time to full enteral feeds (−3.34; 95% CI −4.48 to −2.20 days), reduced duration of PN (−6.32; 95% CI −7.93 to −4.71 days) and reduction in nutrition cost of £867.36 (95% CI £304.72 to £1430.00). Other outcomes were similar between those with and without a TAT including inpatient length of stay (MD −0.97 (−5.03 to 3.09) days), mortality (RD −0.01 (−0.04 to 0.01)) and requirement for repeat surgery (RD 0.01 (−0.03 to 0.05)).ConclusionTAT feeding following CDO repair appears beneficial, without increased risk of adverse events; however, certainty of available evidence is low. Earlier enteral feeding and reduced PN use are known to decrease central venous catheter-associated risks while significantly reducing cost of care.PROSPERO registration numberCRD42022328381.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Bethell,

Neville,

Johnson

et al. 2023

Arch Dis Child Fetal Neonatal Ed

Self Cite

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Factors Associated with Postoperative Complications After Congenital Duodenal Obstruction Surgery: A Retrospective Study

Moga,

Bălănescu,

Bălănescu

et al. 2024

Medicina

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Background and Objectives: Duodenal atresia and stenosis are common causes of intestinal obstruction. Associated anomalies significantly influence early postoperative mortality, while postoperative complications impact long-term survival. Materials and Methods: Over a 13-year period from January 2010 to August 2023, a total of 74 infants and children with congenital duodenal obstruction were treated at “Grigore Alexandrescu” Children’s Emergency Hospital and met the inclusion criteria. All patients diagnosed with duodenal obstruction (both instrinsic and extrinsic causes) were included. Analysed data included congenital anomalies, Apgar scores, birth weights, surgical techniques, and complications. Results: The associated anomalies included cardiac (n = 33), Down syndrome (n = 13), neurological (n = 11), pulmonary (n = 7), renal (n = 4), skeletal (n = 1), and gastrointestinal and hepatobiliopancreatic anomalies (n = 25). In total, 12 patients experienced perioperative ventilation problems. Early postoperative complications (within 30 days) occurred in 21 patients, while 6 had late postoperative complications (after 30 days). Among non-surgical complications, we noted ventilation problems, sepsis (n = 7), and pneumothorax (n = 1). Surgical complications included adhesive bowel obstruction (n = 7), incisional hernia (n = 3), peritonitis (n = 3), dysfunctional duodenoduodenostomy or duodenojejunostomy (n = 3), pneumoperitoneum (n = 5), enteric fistula (n = 3), and volvulus (n = 4). Conclusions: Surprisingly, this retrospective study revealed that an Apgar score below 8, along with neurological and pulmonary abnormalities, is associated with postoperative complications. Conversely, other congenital anomalies, low birth weight, and age at admission do not serve as prognostic factors.

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Factors associated with outcomes in congenital duodenal obstruction: population-based study

Cited by 2 publications

References 12 publications

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

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

Factors Associated with Postoperative Complications After Congenital Duodenal Obstruction Surgery: A Retrospective Study

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