A 5-year single-center retrospect of laparoscopic surgery for neonatal duodenal obstruction

Objective To discuss the approach of imaging diagnosis and the result of minimally invasive surgery for neonatal duodenal obstruction. Methods From January, 2014 to January, 2019, 207 children with neonatal duodenal obstruction treated by laparoscopic surgery were chosen for the paper; of whom, 138 were male and 69 female. The age of surgery was 1 to 28 d, with an average of (7.41±7.81) d. The positive rates of antenatal diagnosis, abdominal X-ray, B-ultrasound, and upper gastrointestinal contrast of neonatal duodenal obstruction were compared. Minimally invasive surgery: diaphragm excision was adopted for duodenal septum, duodenal diamond anastomosis or side-to-side anastomosis for duodenal atresia and annular pancreas, and Ladd's surgery for malrotation. The patients were followed up for 2 months to 5 years. The hospital stay and incidence of postoperative complications were compared. Results The positive rates of antenatal diagnosis, abdominal X-ray, B-mode ultrasound, and upper gastrointestinal contrast were 35.3%, 55.1%, 86.5%, and 92.9%, respectively, with statistical differences (P 0.05). Conclusion The positive rate of upper gastrointestinal contrast of neonatal duodenal obstruction is the highest; B-ultrasound remains the preferred diagnostic approach; and an increasing number of child patients can be diagnosed before birth. Minimally invasive surgery is a growing trend of pediatric surgery, while laparoscopic surgery is an effective approach for neonatal duodenal obstruction. Anastomotic obstruction is the main complication of duodenal septum or atresia and annular pancreas after surgery, while the recurrence of volvulus caused by postoperative adhesion is the main complication of Ladd's surgery. Key words: Laparoscope; Neonates; Duodenal obstruction; Annular pancreas; Malrotation