62 INCIDENCE AND MANAGEMENT OF CONGENITAL DUODENAL ATRESIA AND STENOSIS IN THE UNITED KINGDOM – A POPULATION BASED STUDY
George Bethell1, Anna-May Long2, Marian Knight2, Nigel Hall1, On behalf of BAPS-CASS2
1University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. 2National Perinatal Epidemiology Unit, Oxford, United Kingdom

Abstract

Aim To determine the incidence of duodenal atresia (DA) and stenosis (DS) in the United Kingdom and identify current management strategies, operative techniques and short term outcomes.

Methods DA and DS cases were prospectively identified for one year from March 2016 through the BAPS Congenital Anomalies Surveillance System. Data (median [range]) were collected at day 28 following surgical intervention. Incidence in England was calculated using Office of National Statistics data. (Ethics ref: 12/SC/0416).

Results Overall 100 cases of DA/DS were identified giving an incidence of 1.2 per 10,000 (95% CI 1.0-1.6) live births. Median gestational age at birth was 36 (25-42) weeks and birthweight 2458 (800-4320) grams. DA/DS was suspected prenatally in 59 cases. A pre-operative contrast study was performed in 35. All infants underwent surgical repair (Table) at a median age of 2 (0-75) days, of which 95 procedures were performed open and 5 laparoscopic (including 1 conversion). There were 32 cases of Trisomy 21. Associated abnormalities were identified in 69 cases, including 46 cardiac abnormalities, 21 malrotation, 9 oesophageal atresia +/- trachea-oesophageal fistula, 5 anorectal malformation and 2 distal intestinal atresia. Median hospital stay after repair was 20 (6-73) days and 28 day mortality rate was 2% (95% CI 0.2-7%) from non-related causes.

Conclusion The majority of infants with DA/DS have an associated abnormality including other general surgical anomalies in nearly one third. Open duodenoduodenostomy is the most common procedure. Short term DA/DS outcomes are generally excellent.

Table

 

 

n(%)

Atresia type

I

39(39)

 

II

5(5)

 

III

36(36)

 

Unknown

20(20)

Obstruction site

Pre-ampullary

25(25)

 

Post-ampullary 

45(45)

 

Not known

30(30)

Procedure

Duodenoduodenostomy

77(77)

 

Duodenojejunostomy

14(14)

 

Membrane resection

4(4)

 

Membrane incision

1(1)

 

Other

3(3)

 

Unknown

1(1)

Table – Operative findings and procedure performed


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