title: Outcome of alimentary tract duplications operated on by minimally invasive surgery: a retrospective multicenter study by the GECI (Groupe d'Etude en Coeliochirurgie Infantile).
abstract: BACKGROUND
  Alimentary tract duplications (ATD) are a rare cause of intestinal obstruction in childhood. There are many case reports but few series about laparoscopy or thoracoscopy for ATD. The aim of our study was to report the outcome of minimally invasive surgery (MIS) for ATD.
  
  
  METHODS
  This was a retrospective multicenter study from the GECI (Groupe d'Etude en Coeliochirurgie Infantile). We reviewed the charts of 114 patients operated on by MIS for ATD from 1994 to 2009.
  
  
  RESULTS
  Sixty-two patients (54 %) had a prenatal diagnosis. Forty-nine patients (43 %) were symptomatic before surgery: 33 of those patients (63 %) with postnatal diagnosis compared to 16 (25 %) with prenatal diagnosis (P < 0.01). In this last group, the median age at onset of symptoms was 16 days (range = 0-972). One hundred and two patients had laparoscopy (esophageal to rectal duplications) and 12 patients had thoracoscopy for esophageal duplications. The mean operative time was 90 min (range = 82-98). There were 32 (28 %) resection anastomoses, 55 (48 %) enucleations, and 27 (24 %) unroofings. The conversion rate was 32 %, and in a multivariate analysis, it was significantly higher, up to 41 % for patients weighing <10 kg (P < 0.01). Ten patients (8 %) had unintentional perioperative opening of the digestive tract during the dissection. Eight patients had nine postoperative complications, including six small bowel obstructions. The median length of hospital stay was 4 days (range = 1-21) without conversion and 6 days (range = 1-27) with conversion (P = 0.01). The median follow-up was 3 months (range = 1-120). Eighteen of the 27 patients who underwent partial surgery had an ultrasound examination during follow-up. Five (18 %) of them had macroscopic residue.
  
  
  CONCLUSIONS
  This study showed that MIS for ATD is feasible with a low rate of complications. Patients with prenatal diagnosis should have prompt surgery to prevent symptoms, despite a high rate of conversion in small infants.
authors.affiliation: Department of Pediatric Surgery, Hôpitaux universitaires Paris-Sud, Bicêtre Hospital, Université Paris XI, 78 avenue du Général Leclerc, 94275, Le Kremlin-Bicêtre Cedex, France. florent.guerin-chir@bct.aphp.fr
authors.forename: Florent
authors.initials: F
authors.lastname: Guérin
authors.forename: Guillaume
authors.initials: G
authors.lastname: Podevin
authors.forename: Thierry
authors.initials: T
authors.lastname: Petit
authors.forename: Manuel
authors.initials: M
authors.lastname: Lopez
authors.forename: Pascal
authors.initials: P
authors.lastname: de Lagausie
authors.forename: Hubert
authors.initials: H
authors.lastname: Lardy
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bonnard
authors.forename: François
authors.initials: F
authors.lastname: Becmeur
authors.forename: Paul
authors.initials: P
authors.lastname: Philippe
authors.forename: Michèle
authors.initials: M
authors.lastname: Larroquet
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sapin
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Kurzenne
authors.forename: Aurélie
authors.initials: A
authors.lastname: le Mandat
authors.forename: Caroline
authors.initials: C
authors.lastname: Francois-Fiquet
authors.forename: Jean
authors.initials: J
authors.lastname: Gaudin
authors.forename: Ioannis
authors.initials: I
authors.lastname: Valioulis
authors.forename: Gérard
authors.initials: G
authors.lastname: Morisson-Lacombe
authors.forename: Philippe
authors.initials: P
authors.lastname: Montupet
authors.forename: Martine
authors.initials: M
authors.lastname: Demarche
mesh_terms: D002675:Child, Preschool; D004065:Digestive System Abnormalities / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000145:classification / Q000379:methods* / Q000706:statistics & numerical data*; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000706:statistics & numerical data; D016896:Treatment Outcome