The impact of trisomy 21 on epidemiology, management, and outcomes of congenital duodenal obstruction: a population-based study

Abstract: Purpose: Congenital duodenal obstruction (CDO) is associated with trisomy 21 (T21), or Down’s syndrome, in around a third of infants. The aim of this study was to explore the impact of T21 on the epidemiology, management, and outcomes of infants with CDO. Methods: Data were prospectively collected from specialist neonatal surgical centres in the United Kingdom over a 12 month period from March 2016 using established population-based methodology for all babies with CDO. Infants with T21 were compared to those without any chromosomal anomaly. Results: Of 102 infants with CDO that underwent operative repair, T21 was present in 33 [32% (95% CI 23–41%)] babies. Cardiac anomalies were more common in those with T21 compared to those without a chromosomal anomaly (91 vs 17%, p < 0.001), whereas associated gastrointestinal anomalies were less common in infants with T21 (3 vs 12%, p = 0.03). Surgical management was not influenced by T21. Time to achieve full enteral feed, need for repeat related surgery, and mortality were similar between groups. Infants with T21 had a longer median initial inpatient stay (23 vs 16.5 days, p = 0.02). Conclusions: Infants with T21 have a higher incidence of cardiac anomalies and a longer initial inpatient stay; however, it does not change CDO management or outcomes. This information is important for prenatal and postnatal counselling of parents of infants with CDO and T21

The impact of trisomy 21 on epidemiology, management, and outcomes of congenital duodenal obstruction: a population-based study

Abstract: Purpose: Congenital duodenal obstruction (CDO) is associated with trisomy 21 (T21), or Down’s syndrome, in around a third of infants. The aim of this study was to explore the impact of T21 on the epidemiology, management, and outcomes of infants with CDO. Methods: Data were prospectively collected from specialist neonatal surgical centres in the United Kingdom over a 12 month period from March 2016 using established population-based methodology for all babies with CDO. Infants with T21 were compared to those without any chromosomal anomaly. Results: Of 102 infants with CDO that underwent operative repair, T21 was present in 33 [32% (95% CI 23–41%)] babies. Cardiac anomalies were more common in those with T21 compared to those without a chromosomal anomaly (91 vs 17%, p < 0.001), whereas associated gastrointestinal anomalies were less common in infants with T21 (3 vs 12%, p = 0.03). Surgical management was not influenced by T21. Time to achieve full enteral feed, need for repeat related surgery, and mortality were similar between groups. Infants with T21 had a longer median initial inpatient stay (23 vs 16.5 days, p = 0.02). Conclusions: Infants with T21 have a higher incidence of cardiac anomalies and a longer initial inpatient stay; however, it does not change CDO management or outcomes. This information is important for prenatal and postnatal counselling of parents of infants with CDO and T21

Laparoscopic repair of recurrent congenital diaphragmatic hernia: A case report

Introduction: Recurrent herniation is a well-recognised complication following the repair of a congenital diaphragmatic hernia (CDH). There is no consensus on the optimal surgical approach to manage recurrent CDH. We present a case of laparoscopic correction of recurrent herniation using a non-absorbable patch. Case Presentation: A 13-month old girl presented to the outpatients department with constipation and breath-holding attacks, previously having undergone left CDH surgery on the 7th day of life. The original operation was performed via a subcostal incision and a primary repair was carried out with interrupted non-absorbable sutures. Chest X-ray demonstrated elevation of the left hemi diaphragm with a posterior ‘bulge’ suggesting a recurrence. An elective diagnostic laparoscopy was performed confirming the recurrence with transverse colon herniation through a left postero-lateral diaphragmatic defect size 5 × 5 cm and complete absence of the previously noted posterior rim. There were significant adhesions to the anterior abdominal wall, including the spleen, which were divided and mobilised haemostatically to allow complete assessment of the defect. A patch repair was performed using synthetic mesh anchored with interrupted non-absorbable sutures. Total operating time was under 120 minutes. The patient was discharged on the 3rd post-operative day with minimal analgesic requirements and no evidence of recurrence on follow-up radiographs. Conclusion: Laparoscopic repair is a safe and effective option for cases of CDH recurrence and is technically feasible despite the operative challenges that the surgeon will inevitably face as demonstrated in this case