A modified laparoscopic surgery for congenital duodenal membranes in neonates

Abstract Purpose: To investigate the effectiveness and safety of a modified laparoscopic surgery for neonatal duodenal membrane. Methods: A total of 23 neonates with congenital duodenal membrane were selected from Feb 2012 to Feb 2022. The patients were divided into the control group receiving duodenal membranes resection or rhomboid anastomosis, and the observation group receiving laparoscopic membranes incision, longitudinal incision and transverse suture for the duodenum. The clinical data of all cases were retrospectively reviewed. The operative time, estimated blood loss, time to initial oral feeding, length of stay (LOS), anastomotic obstruction, and incision dehiscence were compared between the two groups. Results: The control group contained 12 children, with average operative time of 133.6±12.8 min, an estimated blood loss of 9.8±2.7 ml, a period of 7.7±2.2 days to initial oral feeding, and an LOS of 12.9±3.8 days. Bilious vomiting was observed in one patient at 15 days after surgery and cured with conservative treatment, and incision dehiscence in two patients and cured by tension-reduced suture. The observation group contained 11 children, with an operative time of 137.7±12.7 min, an estimated blood loss of 7.5±1.9 ml, a period of 6.1±0.9 days to initial oral feeding was, and an LOS of 11.2±2.0 days. There were no conversion to laparotomy, intraoperative or incision complications. Bilious vomiting was observed in one patient at 9 days after surgery and cured with conservative treatment. The period to initial oral feeding and LOS in the observation group were lower than those in the control group (P <0.05). The incidence of incision infection in the control group was 16.7%. The patients were followed up for 3~36 months (mean 15.9 months), all showing normal development. Conclusion: The modified laparoscopy is effective and safe to treat neonates with congenital duodenal membranes.