title: Duodeno-duodenostomy or duodeno-jejunostomy for duodenal atresia: is one repair better than the other?
abstract: OBJECTIVE
  The surgical management of neonates with duodenal atresia (DA) involves re-establishment of intestinal continuity, either by duodeno-duodenostomy (DD) or by duodeno-jejunostomy (DJ). Although the majority of pediatric surgeons perform DD repair preferentially, we aimed to analyze the outcome of DA neonates treated with either surgical technique.
  
  
  METHODS
  Following ethical approval (REB:1000047737), we retrospectively reviewed the charts of all patients who underwent DA repair between 2004 and 2014. Patients with associated esophageal/intestinal atresias and/or anorectal malformations were excluded. Outcome measures included demographics (gender, gestational age, and birth weight), length of mechanical ventilation, time to first and full feed, length of hospital admission, weight at discharge (z-scores), and postoperative complications (anastomotic stricture/leak, adhesive obstruction, and need for re-laparotomy). Both DD and DJ groups were compared using parametric or non-parametric tests, with data presented as mean ± SD or median (interquartile range).
  
  
  RESULTS
  During the study period, 92 neonates met the inclusion criteria. Of these, 47 (51%) had DD and 45 (49%) DJ repair. All procedures were performed open, apart from one laparoscopic DJ. Overall, DD and DJ groups had similar demographics. Likewise, we found no differences between the two groups for length of ventilation (p = 0.6), time to first feed (p = 0.5), time to full feed (p = 0.4), length of admission (p = 0.6), prokinetic use (p = 0.5), nor weight at discharge (p = 0.1). When the 30/92 (33%) patients with trisomy-21 (DD = 16, DJ = 14) were excluded from analysis, the groups still had similar weight at discharge (p = 0.2). Postoperative complication rate was not different between the two groups. One patient per group died, due to respiratory failure (DD) and sepsis (DJ).
  
  
  CONCLUSIONS
  This study demonstrates that in neonates with duodenal atresia, duodeno-duodenostomy and duodeno-jejunostomy have similar outcomes. These findings are relevant for surgeons who repair duodenal atresia laparoscopically, as duodeno-jejunostomy had equal clinical outcomes and may be easier to perform.
authors.affiliation: Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada. augusto.zani@sickkids.ca.|Division of General and Thoracic Surgery, The Hospital for Sick Children, 1524C-555 University Avenue, Toronto, ON, M5G 1X8, Canada. augusto.zani@sickkids.ca.
authors.forename: Augusto
authors.initials: A
authors.lastname: Zani
authors.affiliation: Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.|Division of General and Thoracic Surgery, The Hospital for Sick Children, 1524C-555 University Avenue, Toronto, ON, M5G 1X8, Canada.
authors.forename: Jung-Pin Benjamin
authors.initials: JB
authors.lastname: Yeh
authors.affiliation: Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.|Division of General and Thoracic Surgery, The Hospital for Sick Children, 1524C-555 University Avenue, Toronto, ON, M5G 1X8, Canada.
authors.forename: Sebastian K
authors.initials: SK
authors.lastname: King
authors.affiliation: Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.|Division of General and Thoracic Surgery, The Hospital for Sick Children, 1524C-555 University Avenue, Toronto, ON, M5G 1X8, Canada.
authors.forename: Priscilla P L
authors.initials: PP
authors.lastname: Chiu
authors.affiliation: Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.|Division of General and Thoracic Surgery, The Hospital for Sick Children, 1524C-555 University Avenue, Toronto, ON, M5G 1X8, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wales
mesh_terms: D004380:Duodenal Obstruction / Q000601:surgery*; D004385:Duodenostomy / Q000379:methods*; D004386:Duodenum / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bowel atresia; Neonate; Surgery