Laparoscopic versus open repair of congenital duodenal obstruction in infants

Congenital duodenal obstruction (CDO) is traditionally managed via laparotomy. Laparoscopy has been suggested as an alternative; however, few series have described this in neonatal CDO. We report our series of CDO repaired laparoscopically compared to laparotomy.

After Institutional Review Board approval, a retrospective review was performed on patients with CDO who were presented between October 2001 and July 2010. Duodenal obstruction was managed laparoscopically (LAP) or via an open approach (OPEN) based on the surgeon's choice. Data were analyzed by intention to treat and were expressed as median±range.

Twenty-two neonates underwent laparoscopy and 36 had a traditional laparotomy for management of CDO. Associated diseases included Down's syndrome (n=26), congenital heart disease (n=29), and malrotation (n=16). Median age was 4 days (range: 1-310) for LAP and 3 days (range: 0-166) for OPEN (P=.04). Gestational age and weight were similar (P=.335 and .378). The CDO was due to atresia (n=32), web (n=16), and annular pancreas (n=10). Median operative time for LAP was 116 minutes with a range of 73-164 while median time for OPEN was 103 minutes with a range of 71-220 (P=.013). There was no difference in time to full feedings (P=.69) or postoperative length of stay (P=.682). Ventilation time was 2 days with a range of 0-149 for LAP and ventilation time was 4 days with a range of 0-9 for OPEN (P=.02). Complication rates between the groups were similar.

In the hands of a skilled surgeon, laparoscopy appears to be a safe and effective technique in managing CDO in neonates. In this retrospective study, laparoscopic management of CDO appeared to allow a shorter postoperative ventilator requirement with similar length of stay and time to full feedings. Operative time was slightly longer in the LAP group. Formal prospective trials are recommended to validate these findings.