Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
Department of Epidemiology and Biostatistics Shared Resources, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
J Laparoendosc Adv Surg Tech A. 2022 Feb;32(2):226-230. doi: 10.1089/lap.2021.0557. Epub 2021 Nov 9.
Traditional duodenal atresia (DA) repair involves a laparotomy. There have been reports of laparoscopic repair (LAP), in lieu of the open laparotomy approach (OPN), with varying degrees of success. The merit of this alternative warrants continued investigation. The purpose of this study was to determine whether there were outcome differences after neonatal DA repair based on surgical approach. IRB approved retrospective review of the National Surgical Quality Improvement Program Pediatric database (2012-2018) was conducted. International Classification of Diseases (ICD)-9 (751.1) and ICD-10 codes (Q41.0) identified DA repair. Patient demographics, perioperative, and postoperative variables were collected. Univariate and multivariate analysis was performed. Unadjusted and adjusted logistic regression models assessed associations between surgical approach and outcomes. A total of 917 cases were identified, 803 (87.6%) OPN, 75 (8.2%) LAP, and 39 (4.2%) LAP to OPN. Median age at surgery was 2 days (interquartile range [IQR] = 1-3). Females represented 56% of the LAP ( = 42), and 51% of the OPN ( = 412, = .470). The LAP group had higher weight at surgery (2.8 kg, IQR = 2.3-3.1), compared with the OPN (2.6 kg, IQR = 2.1-2.9, = .009); and longer operative time (161 minutes, IQR = 107-206; OPN 106 minutes, IQR = 85-135, < .001). In unadjusted models, median postoperative stay was 4 days shorter (95% confidence interval = -7.5 to -0.5) among LAP compared with OPN. Adjusted models for postoperative stay, complication risks, and unplanned reoperation were not statistically different. Most DA repairs are performed through OPN. LAP resulted in shorter length of stay in unadjusted models. Similar incidence of complications and reoperation suggest that LAP may be as safe as OPN, when employed by skilled experienced pediatric surgeons.
传统十二指肠闭锁（DA）修复需要剖腹手术。已经有报道称，腹腔镜修复（LAP）可以替代开放式剖腹手术（OPN），并且取得了不同程度的成功。这种替代方法的优点值得进一步研究。本研究的目的是确定基于手术方式，新生儿 DA 修复后的结果是否存在差异。对 2012-2018 年国家手术质量改进计划儿科数据库（National Surgical Quality Improvement Program Pediatric database）进行了机构审查委员会（IRB）批准的回顾性研究。国际疾病分类（ICD）第 9 版（751.1）和 ICD-10 编码（Q41.0）确定了 DA 修复。收集了患者人口统计学、围手术期和术后变量。进行了单变量和多变量分析。未调整和调整后的逻辑回归模型评估了手术方式与结果之间的关联。共确定了 917 例病例，803 例（87.6%）为 OPN，75 例（8.2%）为 LAP，39 例（4.2%）为 LAP 转为 OPN。手术时的中位年龄为 2 天（四分位距[IQR] = 1-3）。女性占 LAP 组的 56%（ = 42），OPN 组的 51%（ = 412， = .470）。与 OPN 组相比，LAP 组的手术时体重更高（2.8kg，IQR = 2.3-3.1），（ = .009）；手术时间更长（161 分钟，IQR = 107-206；OPN 组 106 分钟，IQR = 85-135， < .001）。在未调整的模型中，与 OPN 相比，LAP 组的术后中位住院时间缩短了 4 天（95%置信区间 = -7.5 至-0.5）。调整后的术后住院时间、并发症风险和非计划性再次手术模型没有统计学差异。大多数 DA 修复术是通过 OPN 进行的。LAP 使未调整模型中的住院时间缩短。并发症和再次手术的发生率相似，表明在熟练的有经验的儿科外科医生实施时，LAP 可能与 OPN 一样安全。
