M. D. Smith2, M. P. Landman1 1Indiana University,Division Of Pediatric Surgery, Department Of Surgery,Indianapolis, IN, USA 2Indiana University-Purdue University, Indianapolis,Department Of Biology,Indianapolis, IN, USA
Introduction:
Duodenal Atresia (DA), a common cause of congenital duodenal obstruction, is commonly repaired early in life via intestinal bypass. Many of these patients can have feeding difficulties in the early, postoperative period. DA has a known association with Trisomy 21. The postoperative feeding issues are not well described in this population. We hypothesize that the combination of DA and Trisomy 21 is associated with worse postoperative feeding outcomes and increased need for gastrostomy button placement when compared to non-trisomy DA patients.
Methods:
A retrospective review of patients at Riley Hospital for Children between 2010-2017 with the diagnosis of duodenal atresia or stenosis was performed. Prenatal and postnatal clinical data was abstracted. Additionally, intra-operative and postoperative data was collected. Univariate analyses were performed.
Results:
We identified 43 patients with duodenal atresia; 22 (51.2%) were male. Patients were born at a median gestation age of 37 (IQR 34-38) weeks. Thirty-one (72.1%) of all DA patients were diagnosed prenatally. Nineteen patients (44%) were diagnosed with Trisomy 21. Repair occurred at a median age of 2 (IQR 1-5) days. Postoperative feedings were started on average by day 7 (+/- 3.2 days) and there was no difference between patients with Trisomy 21 (6.47 +/- 3.89 days) and those without Trisomy 21 (7.42 +/- 2.47 days; p = 0.34). There was no difference in days to full enteral nutrition between these groups (13.47 +/- 4.55 vs. 16.46 +/- 9.43 days; p = 0.21). Sixteen patients (84.2%) with Trisomy 21 required gastrostomy at any point versus only 6 (25%) patients without Trisomy 21. On univariate analysis, there was significant association between Trisomy 21 and the lifetime need for gastrostomy button placement (p < 0.001); however, this association did not hold when evaluating the association of gastrostomy during the index admission (p = 0.11).
Conclusion:
Our data suggests that a correlation exists between Trisomy 21, duodenal atresia, and the eventual need for gastrostomy, that may not be evident when only looking at the index admission alone. Surgeons should consider placement of gastrostomy button at the time of DA repair in this population to facilitate postoperative feeding and prevent the need for additional operations to obtain durable feeding access.