Reconstruction for duodenal atresia: tapered or non-tapered duodenoplasty?

The short-term outcome of surgery for congenital duodenal stenosis or atresia has been evaluated by studying the case-notes of 37 patients treated between 1988 and 1993. Eighteen underwent 'tapered' duodeno-duodenostomy; biliary complications occurred in 3 and 1 developed an adhesive intestinal obstruction. Transient post-operative vomiting occurred in 1 other patient. Nineteen patients underwent non-tapered duodeno-duodenostomy. One die 19 days post-operatively; 1 developed an intra-peritoneal abscess and another an adhesive intestinal obstruction. Transient post-operative vomiting occurred in 3 other patients. Full intra-gastric feeding was achieved between a mean of 13 and 14 days in both groups. There was no advantage to either technique with regard to the time of establishment of full intra-gastric feeding. Although there were surgical complications in both groups, it appears that tapered duodenoplasty carries a considerable risk of incidental biliary injury.