Factors affecting early mortality and morbidity in congenital duodenal

International Surgery Factors affecting early mortality and morbidity in congenital duodenal obstruction: summary of a 20-year experience --Manuscript Draft-Manuscript Number:

INTSURG-D-15-00284R1

Full Title:

Factors affecting early mortality and morbidity in congenital duodenal obstruction: summary of a 20-year experience

Article Type:

Original Article

Keywords:

Duodenal obstruction, congenital, early, morbidity, mortality.

Corresponding Author:

Bahattin Aydogdu Dicle University, faculty of medical Diyarbakır, TURKEY

Corresponding Author Secondary Information: Corresponding Author's Institution:

Dicle University, faculty of medical

Corresponding Author's Secondary Institution: First Author:

Bahattin Aydogdu

First Author Secondary Information: Order of Authors:

Bahattin Aydogdu Gulay TIRELI, Associate Professor Oyhan DEMIRALI, Pediatric Surgeon Unal GUVENC, Pediatric Surgeon Cemile BESIK, Pediatric Surgeon Sultan KAVUNCUOGLU, Neonatology Cemil GOYA, Associate Professor Mehmet Hanifi OKUR, Associate Professor Serdar SANDER, Associate Professor

Order of Authors Secondary Information: Abstract:

Purpose: In infants, the duodenum is the most frequently obstructed region of the gastrointestinal tract. The objective of the present study was to summarise the causes of early mortality and morbidity in infants with congenital duodenal obstruction (CDO). Methods: Data on a total of 94 patients with CDO diagnosed in our clinic, and treated surgically between January 1993 and December 2012, were studied retrospectively. Patients were divided into three groups in terms of diagnosis: annular pancreas (n = 45), duodenal atresia (n = 31), and duodenal web (n = 18). The groups were compared in terms of sex, birth weight, age at the time of operation, and morbidity and mortality rates. Results: Of the patients, 54 were males and 40 females, and the mean birth weight was 2,278 (range, 1,180-3,400) g. The average age at the time of the operation was 6.96 (range 1-38) days. The time to full oral intake postoperatively was 10.32 (range, 438) days. Additional anomalies were found in 61 (64.8%) cases. Early morbidity was most commonly associated with an anastomosis problem. Early mortality occurred in 6 (6.4%) cases, and the most common causes were sepsis and cardiac anomalies. Conclusions: Elimination of sepsis, cardiac anomalies, and anastomosis problems are critical to ensure continued reductions in infant mortality and morbidity caused by CDO.

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Introduction Congenital duodenal obstruction (CDO) is one of the most frequent causes of bowel obstruction in infants; the overall incidence is 1 per 5,000-10,000 live births, and the condition is more common in males [1]. CDO may be triggered by embryological defects in foregut development and recanalization as well as rotation anomalies [2, 3]. Duodenoduodenostomy is the surgical treatment of choice, but other techniques can also be used [4, 5, 6]. The most serious early morbidities associated with CDO are anastomotic leakage, peritonitis, sepsis, and anastomosis stenosis. Long-term complications may also develop because of additional anomalies triggering underlying duodenal pathologies [7]. About 25 years ago, the CDO survival rate was 6070%, but now exceeds 95% [6, 8]. The objective of the present study was to summarise our clinical experience with 94 infants with CDO who underwent surgical procedures over the past 20 years. Materials and Methods Data on 94 patients diagnosed with CDO between January 1993 and December 2012 were included in this retrospective study. Patients were divided into three groups according to diagnosis: annular pancreas (AP, n = 45), duodenal atresia (DA, n = 31), and duodenal web (DW, n = 18). The groups were compared in terms of sex, birth weight, age at the time of the operation, and morbidity and mortality rates. Diagnoses was made or confirmed using simple abdominal radiography (Fig. 1), and patients suspected to have CDO underwent barium-passage testing (Fig. 2). All patients were evaluated by neonatal and other relevant specialists if additional anomalies were present. Data were analysed using SPSS software (ver. 15.0; SPSS Inc., Chicago, IL, USA). Continuous variables are expressed as means ± standard deviations (SDs), and categorical variables as numbers with percentages (%). The χ2 test was used to compare categorical data. The Kruskal-Wallis test was used to compare body weights and age at operation between groups. The level of statistical significance was set at p < 0.05 for the Kruskal-Wallis test and