Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2019; 25(28): 3787-3797
Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3787
Comparison of outcomes between complete and incomplete congenital duodenal obstruction
Stefan Gfroerer, Till-Martin Theilen, Henning C Fiegel, Anoosh Esmaeili, Udo Rolle
Stefan Gfroerer, Till-Martin Theilen, Henning C Fiegel, Udo Rolle, Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Frankfurt 60590, Germany
Anoosh Esmaeili, Department of Pediatric Cardiology, University Hospital Frankfurt, Frankfurt 60590, Germany
Author contributions: Gfroerer S, Theilen TM, Esmaeili A, and Rolle U contributed to study conception and design, acquisition, analysis and interpretation of data, and final approval of the version of the article to be published; Gfroerer S drafted of the article; Theilen TM, Esmaeili A, and Rolle U contributed to critical revisions related to the important intellectual content of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the University Hospital Frankfurt.
Informed consent statement: Patients and parents were not required to give informed consent for the study because the analysis used anonymous data that were obtained after the completion of treatment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Stefan Gfroerer, MD, Surgeon, Deputy Head, Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany. stefan.gfroerer@kgu.de
Telephone: +49-69-63016659 Fax: +49-69-63017936
Received: March 29, 2019
Peer-review started: March 29, 2019
First decision: May 30, 2019
Revised: June 13, 2019
Accepted: July 5, 2019
Article in press: July 5, 2019
Published online: July 28, 2019
Processing time: 121 Days and 21 Hours
ARTICLE HIGHLIGHTS
Research background

Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes.

Research motivation

Anatomically, CDO is subdevided into CCDO and ICDO. The clinical observation shows that outcomes between patients with CCDO and ICDO differ substantially.

Research objectives

The objective of this study was to analysis and compare the association between CCDO and ICDO with outcome parameters.

Research methods

We retrospectively reviewed all patients who underwent operative repair of CCDO or ICDO in our tertiary care institution between January 2004 and January 2017. The demographics, clinical presentation, preoperative diagnostics and postoperative outcomes of 50 patients were compared between CCDO (n = 27) and ICDO (n = 23).

Research results

CCDO was associated with a significantly higher prenatal ultrasonographic detection rate, lower gestational age at birth, lower age and weight at operation, higher rate of associated congenital heart disease, more extensive preoperative radiologic diagnostics, higher morbidity according to Clavien-Dindo classification and comprehensive complication index. The subgroup analysis of patients without congenital heart disease (CHD) and prematurity showed a longer time from operation to the initiation of enteral feeds in the CCDO group.

Research conclusions

This study showed that CCDO and ICDO differ with regard to prenatal detection rate, preoperative diagnostics, postoperative enteral feeds, length of hospital stay and morbidity according to the Clavien-Dindo classification and the comprehensive complication index. The degree of CDO in mature patients without CHD influences the postoperative initiation of enteral feeding.

Research perspectives

Efforts should to be undertaken to improve pre- and postnatal detection of ICDO in order to reduce preoperative morbidity and the delay to operative repair.