Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Surg Endosc. 2018 Sep;32(9):3909-3917. doi: 10.1007/s00464-018-6130-3. Epub 2018 Feb 26.
Laparoscopic repair of congenital duodenal obstruction (LCDO) was described more than 15 years ago. However, studies comparing outcomes of LCDO with open repair (OCDO) are rare. Standardized assessments of complications using the Clavien-Dindo classification (CDC) and the comprehensive complication index (CCI) are not available.
All patients undergoing OCDO or LCDO between 2004 and 2017 were identified from the institutional database by retrospective analysis. Postoperative outcomes were assessed, including all complications using the CDC and the CCI.
Forty-seven consecutive patients were identified; 27 patients underwent LCDO and 20 patients had OCDO. Both groups did not differ regarding demographics, associated congenital anomalies, intraoperative pathologic findings, and operative procedures. LCDO was associated with a longer operative time [mean (SD), 202 (89) vs. 112 (41) min, P < 0.0001], shorter time to initiation of feeds [median (range), 1 (0-4) vs. 3 (1-12) days, P = 0.0027], and shorter time to full feeds [mean (SD), 8.2 (4.1) vs. 12.2 (6.4) days, P = 0.0243] compared to OCDO. Shorter length of postoperative hospital stay in LCDO group was achieved for patients without cardiac anomalies [mean (SD), 9.4 (3.1) days in LCDO group vs. 17.2 (9.4) days in OCDO, P = 0.0396] and patients without other anomalies [median (range), 12 (3-38) days in LCDO group vs. 21 (7-31) days in OCDO, P = 0.0460]. LCDO was associated with a lower CCI [median (range) 0 (0-39.7) vs. 4.3 (0-100), P = 0.0270].
Despite a longer operative time for LCDO, a number of advantages of LCDO over OCDO were recognized comparing both approaches in the repair of congenital duodenal obstruction. Such advantages include a lower morbidity, reduced time to initiation and completion of full enteral feeds, and shorter length of postoperative hospitalization for patients without concomitant cardiac anomalies and for patients without other anomalies when operated laparoscopic. In view of the present results, LCDO, performed in selected patients, appears to represent a viable alternative to OCDO.
腹腔镜先天性十二指肠梗阻（LCDO）修复术在 15 年前就已被描述。然而，比较 LCDO 与开放修复术（OCDO）的研究却很少。使用 Clavien-Dindo 分类（CDC）和综合并发症指数（CCI）对并发症进行标准化评估尚不可用。
通过回顾性分析，从机构数据库中确定了 2004 年至 2017 年间行 OCDO 或 LCDO 的所有患者。评估术后结果，包括使用 CDC 和 CCI 评估所有并发症。
共确定了 47 例连续患者，其中 27 例行 LCDO，20 例行 OCDO。两组在人口统计学特征、合并的先天性异常、术中病理发现和手术程序方面无差异。与 OCDO 相比，LCDO 具有更长的手术时间[平均（标准差），202（89）比 112（41）分钟，P<0.0001]，更短的开始喂养时间[中位数（范围），1（0-4）比 3（1-12）天，P=0.0027]和完全喂养时间[平均（标准差），8.2（4.1）比 12.2（6.4）天，P=0.0243]。对于无心脏异常的患者，LCDO 组的术后住院时间更短[平均（标准差），9.4（3.1）天在 LCDO 组比 17.2（9.4）天在 OCDO 组，P=0.0396]和无其他异常的患者[中位数（范围），12（3-38）天在 LCDO 组比 21（7-31）天在 OCDO 组，P=0.0460]。LCDO 与较低的 CCI 相关[中位数（范围）0（0-39.7）比 4.3（0-100），P=0.0270]。
尽管 LCDO 的手术时间较长，但与 OCDO 相比，LCDO 在治疗先天性十二指肠梗阻方面具有许多优势。这些优势包括较低的发病率、开始和完成全肠内喂养的时间缩短，以及对于没有伴发心脏异常的患者和对于没有其他异常的患者，术后住院时间缩短。鉴于目前的结果，对于选定的患者，LCDO 似乎是 OCDO 的可行替代方案。
