Abstract
Purpose
To determine the effect of trans-anastomotic tube (TAT) feeding on outcome following repair of congenital duodenal obstruction (CDO).
Methods
Retrospective comparative study of all infants with CDO over 10 years. Data are median (range). Mann–Whitney U test and Fisher’s exact test were used.
Results
Of 55 infants with CDO (48 atresia, 7 stenosis), 17 were managed with a TAT, 38 without. Enteral feeds were commenced earlier in infants with a TAT compared to those without (TAT 2 days post-repair [1–4] vs. no-TAT 3 days post-repair [1–7]; p = 0.006). Infants with a TAT achieved full enteral feeds significantly sooner than those without (TAT 6 days post-repair [2–12] vs. no-TAT 9 days post-repair [3–36]; p = 0.005). Significantly fewer infants in the TAT group required central venous catheter (CVC) placement and parenteral nutrition (PN) than in the no-TAT group (TAT 2/17 vs. no-TAT 28/38, p < 0.0001). There were six CVC-related complications (5 infections, 1 PN extravasation) and four TATs became displaced and were removed before achieving full enteral feeds. One infant with a TAT with trisomy 21 and undiagnosed Hirschsprung disease developed an anastomotic leak and jejunal perforation requiring re-operation.
Conclusions
A TAT significantly shortens time to full enteral feeds in infants with CDO significantly reducing the need for central venous access and PN.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Applebaum H, Lee SL, Puapong DP (2006) Duodenal atresia and stenosis-annular pancreas. In: Grosfeld JL, O’Neill JA, Fonkalsrud EW et al (eds) Pediatric Surgery, 6th edn. Mosby, Philadelphia, pp 1260–1268
Intestinal atresia (2009) In: Davenport M, Pierro A (eds) Oxford Handbook of Paediatric Surgery, 1st edn. Oxford University Press, Oxford, pp 146–149
Dagli TE (2010) Neonatal gastrointestinal obstruction. In: Burge DM, Griffiths DM, Steinbrecher HA et al (eds) Paediatric Surgery, 2nd edn. Hodder Arnold, London, pp 135–145
Millar AJW, Rode H, Cwyes S (2005) Intestinal atresia and stenosis. In: Ashcraft KW, Holcomb GW, Murphy JP (eds) Pediatric Surgery. Elsevier Saunders, Philadelphia, pp 416–434
Upadhyay V, Sakalkale R, Parashar K et al (1996) Duodenal atresia: a comparison of three modes of treatment. Eur J Pediatr Surg 6:75–77
Mooney D, Lewis JE, Connors RH, Weber TR (1987) Newborn duodenal atresia: an improving outlook. Am J Surg 153:347–349
Arnbjornsson E, Larsson M, Finkel Y, Karpe B (2002) Transanastomotic feeding tube after an operation for duodenal atresia. Eur J Pediatr Surg 12:159–162
Ruangtrakool R, Mungnirandr A, Laohapensang M, Sathornkich C (2001) Surgical treatment for congenital duodenal obstruction. J Med Assoc Thai 84:842–849
Acknowledgments
We acknowledge the assistance of Dr Simon Eaton, UCL Institute of Child Health, London, UK with statistical analysis.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hall, N.J., Drewett, M., Wheeler, R.A. et al. Trans-anastomotic tubes reduce the need for central venous access and parenteral nutrition in infants with congenital duodenal obstruction. Pediatr Surg Int 27, 851–855 (2011). https://doi.org/10.1007/s00383-011-2896-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-011-2896-2