Abstract
Background
Alimentary tract duplications (ATD) are a rare cause of intestinal obstruction in childhood. There are many case reports but few series about laparoscopy or thoracoscopy for ATD. The aim of our study was to report the outcome of minimally invasive surgery (MIS) for ATD.
Methods
This was a retrospective multicenter study from the GECI (Groupe d’Etude en Coeliochirurgie Infantile). We reviewed the charts of 114 patients operated on by MIS for ATD from 1994 to 2009.
Results
Sixty-two patients (54 %) had a prenatal diagnosis. Forty-nine patients (43 %) were symptomatic before surgery: 33 of those patients (63 %) with postnatal diagnosis compared to 16 (25 %) with prenatal diagnosis (P < 0.01). In this last group, the median age at onset of symptoms was 16 days (range = 0–972). One hundred and two patients had laparoscopy (esophageal to rectal duplications) and 12 patients had thoracoscopy for esophageal duplications. The mean operative time was 90 min (range = 82–98). There were 32 (28 %) resection anastomoses, 55 (48 %) enucleations, and 27 (24 %) unroofings. The conversion rate was 32 %, and in a multivariate analysis, it was significantly higher, up to 41 % for patients weighing <10 kg (P < 0.01). Ten patients (8 %) had unintentional perioperative opening of the digestive tract during the dissection. Eight patients had nine postoperative complications, including six small bowel obstructions. The median length of hospital stay was 4 days (range = 1–21) without conversion and 6 days (range = 1–27) with conversion (P = 0.01). The median follow-up was 3 months (range = 1–120). Eighteen of the 27 patients who underwent partial surgery had an ultrasound examination during follow-up. Five (18 %) of them had macroscopic residue.
Conclusion
This study showed that MIS for ATD is feasible with a low rate of complications. Patients with prenatal diagnosis should have prompt surgery to prevent symptoms, despite a high rate of conversion in small infants.
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Acknowledgments
The authors thank Dr. Jacques Guitard, Mrs. Aurore Thollot, Dr. Patrice Erpicum, and Pr. François Varlet for their assistance in collecting the data, and Ms. Eichner-Raja for revising the manuscript.
Disclosures
Florent Guerin, Guillaume Podevin, Thierry Petit, Manuel Lopez, Pascal Delagausie, Hubert Lardy, Arnaud Bonnard, François Becmeur, Paul Philippe, Michelle Larroquet, Emmanuel Sapin, Jean Yves Kurzenne, Aurélie le Mandat, Caroline Francois-Fiquet, Jean Gaudin, Ioannis Valioulis, Gerard Morisson-Lacombe, Philippe Montupet, Martine Demarche for the GECI (Groupe d’Etude en Coeliochirurgie Infantile) have no conflicts of interest or financial ties to disclose.
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This study was conducted on behalf of the GECI (Groupe d’Etude en Coeliochirurgie Infantile). The members of this study group are listed in the appendix.
Appendix: GECI (Groupe d’Etude en Coeliochirurgie Infantile)
Appendix: GECI (Groupe d’Etude en Coeliochirurgie Infantile)
Florent Guerin, Guillaume Podevin, Thierry Petit, Manuel Lopez, Pascal de Lagausie, , Hubert Lardy, Arnaud Bonnard, Franc¸ois Becmeur,Paul Philippe,Michèle Larroquet, Emmanuel Sapin, Jean Yves Kurzenne, , Aurèlie le Mandat, Caroline Francois-Fiquet, Jean Gaudin, Ioannis Valioulis, Gèrard Morisson-Lacombe, Philippe Montupet, Martine Demarche.
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Guérin, F., Podevin, G., Petit, T. et al. Outcome of alimentary tract duplications operated on by minimally invasive surgery: a retrospective multicenter study by the GECI (Groupe d’Etude en Coeliochirurgie Infantile). Surg Endosc 26, 2848–2855 (2012). https://doi.org/10.1007/s00464-012-2259-7
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DOI: https://doi.org/10.1007/s00464-012-2259-7