title: Laparoscopic management of congenital duodenal atresia or stenosis: A single-center early experience.
abstract: BACKGROUND
  The background is to review our experience with laparoscopic repair of congenital duodenal atresia or stenosis (CDAS) and compare postoperative outcome with a group control of laparotomy repair.
  
  
  METHODS
  Retrospective chart review of all cases of CDAS undergoing laparoscopic surgery at our institution between July 2013 and May 2014 and comparison with a group control of open operation performed between 2007 and 2010. Data were compared using Fisher's exact test for qualitative values and Mann-Whitney test for quantitative values. P values less than 0,05 were considered statistically significant.
  
  
  RESULTS
  Ten consecutive cases were identified in laparoscopic group (7 duodenoduodenostomy and 3 duodenojejunostomy) and 19 cases in laparotomy group (16 duodenoduodenostomy and 3 web excision). Median birth weight was lower in laparoscopic group (2125 grams Vs 2777 grams p=0,04). In laparoscopic group, there was no conversion and no intraoperative complication. Median duration of surgery was 90minutes (80-150). In both groups, the surgical morbidity rate was 10%. Median time to initiation of oral feeding was significatively shorter in laparotomy group (8days Vs 4 p=0,009). Median time to full oral feeding and length of stay were shorter in laparotomy but not statistically different. (36days Vs 16,5 p=0,14 and 45,5days Vs 25,5 p=0,09 respectively) After a median follow up of 149,5days (24-355) in laparoscopic group, 8 children had a full oral intake. Five children had a weight below the 10th percentile.
  
  
  CONCLUSIONS
  The laparoscopic approach for CDAS is safe and reproducible with outcomes similar to open repair even in the beginning of a learning curve for pediatric surgeons with appropriate laparoscopic skills. In this small series, laparoscopy did not appear to decrease time to full oral intake or length of stay. Larger studies are suggested to provide more conclusive results.
authors.affiliation: Pediatric Surgery Department, Robert Debré University Hospital, APHP, Paris, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Parmentier
authors.affiliation: Pediatric Surgery Department, Robert Debré University Hospital, APHP, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Peycelon
authors.affiliation: Pediatric Surgery Department, Robert Debré University Hospital, APHP, Paris, France.
authors.forename: Cécile-Olivia
authors.initials: CO
authors.lastname: Muller
authors.affiliation: Pediatric Surgery Department, Robert Debré University Hospital, APHP, Paris, France; Paris VII University, Paris, France.
authors.forename: Alaa
authors.initials: A
authors.lastname: El Ghoneimi
authors.affiliation: Pediatric Surgery Department, Robert Debré University Hospital, APHP, Paris, France; Paris VII University, Paris, France. Electronic address: arnaud.bonnard@rdb.aphp.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bonnard
mesh_terms: D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000151:congenital / Q000601:surgery*; D004380:Duodenal Obstruction / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Duodenal atresia; Laparoscopic repair; Pediatric surgery