Duodenal Obstruction

Abstract

The duodenum is the most common site of neonatal intestinal obstruction, accounting for 50% of all intestinal atresias. Duodenal obstruction (DO) is often complicated by prematurity and associated anomalies. Early prenatal ultrasonographic diagnosis of DO allows the mother karyotype analysis for trisomy 21 and other associated anomalies. Cardiac malformations are the major cause of morbidity and mortality in patients with congenital DO. For most causes of congenital DOs, duodenoduodenostomy via an open approach is the preferred surgical procedure. Vidal from France and Ernst from the Netherlands are credited with the first successful repairs in 1905 and 1914, respectively. Over the last decade, the application of minimally invasive surgical techniques (MIS) and the advent of smaller laparoscopic instruments have expanded the potential of laparoscopy for repair of congenital DO. The first reported laparoscopic repairs of duodenal atresia were by Bax in 2001 and Rothenberg in 2002. The last retrospective studies comparing the surgical outcome of laparoscopic repair versus open repair found that laparoscopy is a safe and effective technique, and the results including operative time, length of stay, time to full feeding, and complication rate were similar in both groups. The long-term survival rate of patients with DO is excellent and greater than 95% resulting from an early surgical intervention combined with advancement in neonatal intensive care, anesthesia, and nutritional support.