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Congenital duodenal obstruction in the United Kingdom – a population-based study

Congenital duodenal obstruction in the United Kingdom – a population-based study
Congenital duodenal obstruction in the United Kingdom – a population-based study
Objective: Congenital duodenal obstruction (CDO) comprising duodenal atresia or stenosis is a rare congenital anomaly requiring surgical correction in early life. Identification of variation in surgical and postoperative practice in previous studies has been limited by small sample sizes. This study aimed to prospectively estimate the incidence of CDO in the UK, and report current management strategies and short-term outcomes.

Design: Prospective population-based, observational study for 12 months from March 2016.

Setting: Specialist neonatal surgical units in the UK.

Main outcome measures: Incidence of CDO, associated anomalies and short-term outcomes.

Results: In total, 110 cases were identified and data forms were returned for 103 infants giving an estimated incidence of 1.22 cases per 10 000 (95% CI 1.01 to 1.49) live births. Overall, 59% of cases were suspected antenatally and associated anomalies were seen in 69%. Operative repair was carried out mostly by duodenoduodenostomy (76%) followed by duodenojejunostomy (15%). Postoperative feeding practice varied with 42% having a trans-anastomotic tube placed and 88% receiving parenteral nutrition. Re-operation rate related to the initial procedure was 3% within 28 days. Two infants died within 28 days of operation from unrelated causes.

Conclusion: This population-based study of CDO has shown that the majority of infants have associated anomalies. There is variation in postoperative feeding strategies which represent opportunities to explore the effects of these on outcome and potentially standardise approach. Short-term outcomes are generally good.
0003-9888
Bethell, George S.
9c442b15-1e62-4b7a-8334-85024c37ecc2
Long, Anna-May
cb5ff398-cbcd-4a87-b9bd-8f53b9fd0dd9
Knight, Marion
eccada1b-ce1e-4571-ae08-607113255a36
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
On behalf of BAPS-CASS
Bethell, George S.
9c442b15-1e62-4b7a-8334-85024c37ecc2
Long, Anna-May
cb5ff398-cbcd-4a87-b9bd-8f53b9fd0dd9
Knight, Marion
eccada1b-ce1e-4571-ae08-607113255a36
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf

Bethell, George S., Long, Anna-May, Knight, Marion and Hall, Nigel J. , On behalf of BAPS-CASS (2019) Congenital duodenal obstruction in the United Kingdom – a population-based study. Archives of Disease in Childhood. (doi:10.1136/archdischild-2019-317085).

Record type: Article

Abstract

Objective: Congenital duodenal obstruction (CDO) comprising duodenal atresia or stenosis is a rare congenital anomaly requiring surgical correction in early life. Identification of variation in surgical and postoperative practice in previous studies has been limited by small sample sizes. This study aimed to prospectively estimate the incidence of CDO in the UK, and report current management strategies and short-term outcomes.

Design: Prospective population-based, observational study for 12 months from March 2016.

Setting: Specialist neonatal surgical units in the UK.

Main outcome measures: Incidence of CDO, associated anomalies and short-term outcomes.

Results: In total, 110 cases were identified and data forms were returned for 103 infants giving an estimated incidence of 1.22 cases per 10 000 (95% CI 1.01 to 1.49) live births. Overall, 59% of cases were suspected antenatally and associated anomalies were seen in 69%. Operative repair was carried out mostly by duodenoduodenostomy (76%) followed by duodenojejunostomy (15%). Postoperative feeding practice varied with 42% having a trans-anastomotic tube placed and 88% receiving parenteral nutrition. Re-operation rate related to the initial procedure was 3% within 28 days. Two infants died within 28 days of operation from unrelated causes.

Conclusion: This population-based study of CDO has shown that the majority of infants have associated anomalies. There is variation in postoperative feeding strategies which represent opportunities to explore the effects of these on outcome and potentially standardise approach. Short-term outcomes are generally good.

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Congenital duodenal obstruction in the United Kingdom – a population-based study - Accepted Manuscript
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Accepted/In Press date: 26 May 2019
e-pub ahead of print date: 22 June 2019

Identifiers

Local EPrints ID: 431741
URI: http://eprints.soton.ac.uk/id/eprint/431741
ISSN: 0003-9888
PURE UUID: e2e303fa-a6e1-476c-80f6-be66d77b4e1d
ORCID for Nigel J. Hall: ORCID iD orcid.org/0000-0001-8570-9374

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Date deposited: 14 Jun 2019 16:30
Last modified: 16 Mar 2024 07:56

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Contributors

Author: George S. Bethell
Author: Anna-May Long
Author: Marion Knight
Author: Nigel J. Hall ORCID iD
Corporate Author: On behalf of BAPS-CASS

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