Laparoscopic duodenoduodenostomy in neonates: Modification of the technique and clinical outcomes

Abstract

Background . Congenital duodenal obstruction (CDO) is a rare malformation. Since laparoscopic repair was introduced in 2001, issues of reproducibility and optimal perioperative management in neonates remain debated. Aim. To analyze our experience of implementation of laparoscopic duodenoduodenostomy in neonates with CDO, to assess the impact of technical modifications and perioperative management on early outcomes, and to analyze technical difficulties and complications. Materials and methods . We retrospectively reviewed 27 neonates treated for CDO from September 2017 to December 2021. Prenatal diagnosis was established in 17 (63 %) cases; postnatal confirmation was based on X-rays, with upper gastrointestinal tract contrast study when necessary. Four infants underwent open repair via circumumbilical incision; 23 underwent laparoscopic repair. Group I (n = 13) included children who underwent surgery without modification of the technique, Group II (n = 10) included children who underwent modified surgery. Results . Group II demonstrated a significant reduction in operative time, duration of inotropic support, mechanical ventilation, intensive care unit stay, and time to initiation of enteral feeding (p <0.05). Prolonged epidural analgesia was used more frequently in Group II (p = 0.019), while the need for systemic opioids did not differ. Differences in intraoperative complications, postoperative complications, and mortality were not statistically significant. Intraoperative complication was reported in 1 patient (injury of an atypically located pancreatic duct). Anastomotic leak was observed in 2 patients, and duodenal perforation was reported in 2 patients. Mean hospital stay was 29 ± 10.5 days; mean follow-up was 34 ± 11.2 months, with no clinically significant late anastomotic obstruction detected. Conclusion . Implementation of laparoscopic duodenoduodenostomy in neonates is feasible and is associated with improved early resource-related outcomes when the technique and perioperative management are standardized. The effect of technique modification on decreasing complication rate and unfavorable outcomes requires confirmation through larger studies.