title: Trans-anastomotic tubes reduce the need for central venous access and parenteral nutrition in infants with congenital duodenal obstruction.
abstract: OBJECTIVE
  To determine the effect of trans-anastomotic tube (TAT) feeding on outcome following repair of congenital duodenal obstruction (CDO).
  
  
  METHODS
  Retrospective comparative study of all infants with CDO over 10 years. Data are median (range). Mann-Whitney U test and Fisher's exact test were used.
  
  
  RESULTS
  Of 55 infants with CDO (48 atresia, 7 stenosis), 17 were managed with a TAT, 38 without. Enteral feeds were commenced earlier in infants with a TAT compared to those without (TAT 2 days post-repair [1-4] vs. no-TAT 3 days post-repair [1-7]; p = 0.006). Infants with a TAT achieved full enteral feeds significantly sooner than those without (TAT 6 days post-repair [2-12] vs. no-TAT 9 days post-repair [3-36]; p = 0.005). Significantly fewer infants in the TAT group required central venous catheter (CVC) placement and parenteral nutrition (PN) than in the no-TAT group (TAT 2/17 vs. no-TAT 28/38, p < 0.0001). There were six CVC-related complications (5 infections, 1 PN extravasation) and four TATs became displaced and were removed before achieving full enteral feeds. One infant with a TAT with trisomy 21 and undiagnosed Hirschsprung disease developed an anastomotic leak and jejunal perforation requiring re-operation.
  
  
  CONCLUSIONS
  A TAT significantly shortens time to full enteral feeds in infants with CDO significantly reducing the need for central venous access and PN.
authors.affiliation: Wessex Regional Centre for Paediatric Surgery, Southampton University Hospitals NHS Trust, Mailpoint 44, Tremona Road, Southampton, SO16 6YD, UK. n.hall@suht.swest.nhs.uk
authors.forename: N J
authors.initials: NJ
authors.lastname: Hall
authors.forename: M
authors.initials: M
authors.lastname: Drewett
authors.forename: R A
authors.initials: RA
authors.lastname: Wheeler
authors.forename: D M
authors.initials: DM
authors.lastname: Griffiths
authors.forename: L J
authors.initials: LJ
authors.lastname: Kitteringham
authors.forename: D M
authors.initials: DM
authors.lastname: Burge
mesh_terms: D000714:Anastomosis, Surgical; D002405:Catheterization, Central Venous / Q000379:methods / Q000706:statistics & numerical data*; D004380:Duodenal Obstruction / Q000151:congenital / Q000628:therapy*; D004386:Duodenum / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007583:Jejunum / Q000601:surgery*; D010289:Parenteral Nutrition, Total / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome