The role of parenteral nutrition following surgery for duodenal atresia or stenosis

Bishay, Mark; Lakshminarayanan, Bhanumathi; Arnaud, Aurélie; Garriboli, Massimo; Cross, Kate; Curry, Joseph I.; Drake, D. P.; Kiely, Edward M.; Coppi, Paolo De; Pierro, Agostino; Eaton, Simon

doi:10.1007/s00383-012-3200-9

Cited by 27 publications

(19 citation statements)

References 9 publications

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“…Similar to a recently published study, the small subset of patients ( n = 6) in our study who never received PN had a faster transition to full enteral nutrition, 7 days versus 12 days for the entire cohort [16]. The two variables though, that had the greatest influence overall, were prematurity and presence of CHD; both were noted to be associated with increased odds of delayed transition to full enteral nutrition and outweighed all other variables.…”

Section: Discussionsupporting

confidence: 83%

“…This does suggest that the evaluation for presence of concurrent obstruction may be worthwhile to avoid the morbidity associated with a missed lesion. Other major complications did include line sepsis in two patients; however, there was not an increased rate in the highest risk groups [10, 16]. Secondly, there was a small degree of a time-epoch phenomena.…”

Section: Discussionmentioning

confidence: 99%

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A Modern Cohort of Duodenal Obstruction Patients: Predictors of Delayed Transition to Full Enteral Nutrition

Bairdain

Lien

et al. 2014

Journal of Nutrition and Metabolism

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Background. A common site for neonatal intestinal obstruction is the duodenum. Delayed establishment of enteral nutritional autonomy continues to challenge surgeons and, since early institution of nutritional support is critical in postoperative newborns, identification of patients likely to require alternative nutritional support may improve their outcomes. Therefore, we aimed to investigate risk factors leading to delayed establishment of full enteral nutrition in these patients. Methods. 87 patients who were surgically treated for intrinsic duodenal obstructions from 1998 to 2012 were reviewed. Variables were tested as potential risk factors. Median time to full enteral nutrition was estimated using the Kaplan-Meier method. Independent risk factors of delayed transition were identified using the multivariate Cox proportional hazards regression model. Results. Median time to transition to full enteral nutrition was 12 days (interquartile range: 9–17 days). Multivariate Cox analysis identified three significant risk factors for delayed enteral nutrition: gestational age (GA) ≤ 35 weeks (P < .001), congenital heart disease (CHD) (P = .02), and malrotation (P = .03). Conclusions. CHD and Prematurity are most commonly associated with delayed transition to full enteral nutrition. Thus, in these patients, supportive nutrition should strongly be considered pending enteral nutritional autonomy.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

A Modern Cohort of Duodenal Obstruction Patients: Predictors of Delayed Transition to Full Enteral Nutrition

Bairdain

Lien

et al. 2014

Journal of Nutrition and Metabolism

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“…3,[5][6][7] Correspondingly, the duration of PN was also reduced after laparoscopic repair. While PN is known to increase the risk of cholestasis, thrombosis, and the rate of sepsis, 10,11 we were unable to demonstrate a benefit of MIS regarding the occurrence of line infections in our patient cohort. Interestingly, our experience is similar to other reports when considering MIS, but it is superior to others when considering the open approach in that our patients who had open surgery reached full feeds sooner than in other published series.…”

Section: Discussionmentioning

confidence: 61%

Potential Benefits of Laparoscopic Repair of Duodenal Atresia: Insights from a Retrospective Comparative Study

et al. 2019

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Introduction Congenital duodenal obstruction (CDO) repair can be performed open or laparoscopically. We aimed to determine the potential benefit of laparoscopic repair regarding tolerance of enteral feeding, postoperative pain, hospital stay, and complication rate. Materials and Methods In a single-center retrospective cohort study, we compared neonates with isolated CDO operated open versus laparoscopically from 2010 to 2019. No transanastomotic tubes were used, and anastomoses were created in a side-to-side fashion in all cases. An early feeding policy is applied for all cases operated at our institution. Statistical comparison was performed using the Mann–Whitney's test or Fisher's exact test where appropriate. Results Forty-one patients analyzed were similar regarding body weight, gestational age, and proportion of patients with trisomy 21. Median follow-up was 21 months. Four (20%) out of 20 laparoscopic procedures started laparoscopically were converted to open. Comparing the 21 open with the 16 laparoscopically completed patients, median anesthetic duration was shorter by 18% in the open versus laparoscopic completed group (218 vs. 179 minutes, respectively; p = 0.025). Median postoperative time to full enteral feeds was shorter by 4 days in the first group (7 vs. 11 days, respectively; p = 0.028). In accordance, the median duration of parenteral nutrition (PN) was less than half in the laparoscopic completed compared with the open group (5 vs. 11.5 days, respectively; p = 0.031). Postoperative opioids were required for only half the duration in the laparoscopically completed group compared with open (2 vs. 4 days, respectively; p = 0.026). Outcomes such as length of stay, the occurrence of strictures or adhesions requiring reintervention, or line sepsis were similar in both groups. Conclusion Patients undergoing laparoscopic CDO repair at our institution benefited from shorter time to full enteral feeds, and reduced the need for PN as well as postoperative pain medication.

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“…Bu nedenle, zaman içindeki enfeksiyon tedbirleri ile ilgili kesin bir şey söylenemez. Ancak söz konusu sepsis olunca şaşırtıcı bir şekilde zamana olan bir artış görülmüştür (18 (8,10,13). Konunun semptomatolojik olarak değerlendirilmesine atfen bir önem düşünülmediği anlaşılmaktadır.…”

Section: Discussionunclassified

“…Operasyonlarda dokuz olguda (% 66.5) tip1 atrezi, beş olguda (%31) annüler pankreas, iki olguda (%12.5) tip 2 atrezi görüldü. Hastalarda ortalama TPN alma süresi 8.4 (6)(7)(8)(9)(10)(11)(12)(13)(14) gün, oral beslenmeye başlama süresi 6.31(5-9) gün ve ortalama yatış süreleri 17.56 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) gündü. Olguların hiçbirinde cerrahi komplikasyon görülmedi ve tüm olgular tam iyileşme ile taburcu edildi.…”

Section: Bulgularunclassified

Konjenital duodenal obstrüksiyonlarına klinik yaklaşım

Öztorun

Ertürk

Demir

et al. 2020

Turkish Journal of Pediatric Disease

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ÖZAmaç: Yenidoğan dönemindeki intestinal obstruksiyonların çoğunluğunu konjenital duodenal obstrüksiyonlar oluşturur. Preoperatif ve postoperatif yenidoğan yoğun bakım uygulamaları ve uygun nutrisyonel tedaviler sayesinde morbidite ve mortalite önemli derecede azalmasına rağmen, literatürde duodenal obstrüksiyonlara zaman içerisinde yapılan müdahaleleri kıyaslayan çalışmaların yapılmadığı görülmektedir. Çalışmamızda, kliniğimizdeki konjenital duodenal obstruksiyonlu olguların klinik bilgilerini, literatürde sunulan klinik bilgiler ile karşılaştırarak, konjenital duodenal obstruksiyonların tedavisinin zaman içindeki sürecini incelemeyi amaçladık. Gereç veYöntemler: 2006-2016 yıllarında kliniğimizde tedavi edilen konjenital duodenal obstruksiyon tanılı 16 olgu gestasyonel yaşı, cinsiyeti, doğum ağrılığı, başvuru günü, şikayeti, ek anomalileri, ameliyat zamanı, yapılan ameliyat, beslenme zamanı, yatış süresi ve takip açısından retrospektif olarak incelenip literatürdeki benzer çalışmalar ile karşılaştırılarak, günümüzdeki konjenital duodenal obstruksiyonların tedavisinin durumu tartışılmıştır. Bulgular: Dokuz olgu erkek, 7 olgu kız olmak üzere, %69 olgu prematüreydi. Ortalama gestasyonel yaş 34.8 (29-40) haftaydı. Klinik şikayetler 11 olguda kusma, 4 olguda batın distansiyonu ve bir olguda ise genel durum bozukluğutu. Konjenital kalp hastalığı sekiz olguda, Down Sendromu beş olguda ve iki olguda malrotasyon tespit edildi. Cerrahi yöntem olarak en sık olarak 12 olguya Diamond-Shape duodenoduodenostomi uygulandı. Ortalama total parental nutrisyon (TPN) alma süresi 8.4 gün ve ortalama yatış süreleri 17.56 gündü. Olguların tümünde cerrahi komplikasyon görülmeyerek, tam iyileşme ile taburcu edildi.Sonuç: Literatür değerlendirmemizde cerrahi süreçlerin kesitsel olarak verildiği ancak hastalığın bütünsel incelemesinin daha az yapıldığını görüldü. Yapılan karşılaştırmalarda, zaman içerisinde mortalitenin anlamlı şekilde azalma gösterdiği ancak cerrahi tekniklerde ve beslenmeye başlama günü ortalamalarında değişme olmadığı görüldü. Dikkat çekici olarak, sepsis oranlarında artış gözlendi. Literatürdeki olguların çoğunluğunun prematür bebekler olması, hastanede uzun kalış süreleri ve bu olguların göreceli olarak düşük immünitelerinin olması, sepsis oranlarındaki artışı açıklayabilir. Bu durumda, servis şartlarının daha iyi belirlenmesi ve postoperatif enteral ve parenteral beslenme ile mortalite ve morbidite arasında daha detaylı korelasyon çalışmalarının yapılması gerektiğini önermekteyiz.Anahtar Sözcükler: Konjenital duodenal obstrüksiyon, Yenidoğan, Yoğun bakım ABSTRACT Objective: Congenital duodenal obstructions consitute the majority of intestinal obstructions in the neonatal period. Although, morbidity and mortality have decreased significantly with preoperative and postoperative neonatal intensive care and appropriate nutritional therapies, it is seen that there are no studies comparing the interventions in duodenal obstructions over time. In our study, we aimed to examine the process of treatment of congenital duodenal...

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The role of parenteral nutrition following surgery for duodenal atresia or stenosis

Abstract: Children with duodenal atresia/stenosis can be managed without PN. However, a third of these children subsequently require PN, lose weight centiles, and have a high rate of sepsis.

Cited by 27 publications

References 9 publications

A Modern Cohort of Duodenal Obstruction Patients: Predictors of Delayed Transition to Full Enteral Nutrition

A Modern Cohort of Duodenal Obstruction Patients: Predictors of Delayed Transition to Full Enteral Nutrition

Potential Benefits of Laparoscopic Repair of Duodenal Atresia: Insights from a Retrospective Comparative Study

Konjenital duodenal obstrüksiyonlarına klinik yaklaşım

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