Transanastomotic tube following surgery for congenital duodenal obstruction: its effect on nutrition and clinical outcomes.

PURPOSE: Congenital duodenal obstruction (CDO) is a common neonatal intestinal obstruction associated with prematurity, low birth weight, and additional anomalies. Postoperative enteral feeding delays, caused by proximal duodenal dysmotility and anastomotic edema, prolong the need for total parenteral nutrition (TPN) and the use of a central venous catheter (CVC). The transanastomotic tube (TAT) bypasses the dysfunctional segment for direct jejunal feeding. This study evaluated effects of TAT on outcomes, TPN/CVC requirements, complications, and hospitalization duration in neonates undergoing CDO repair.

METHODS

Forty-eight CDO patients (January 2012-January 2021) were retrospectively reviewed. After excluding 7 pre-feeding deaths and 5 early TAT removals, 36 patients were analyzed: TAT(+) (n = 21) and TAT(-) (n = 15). Demographic characteristics, obstruction type, surgical technique, anomalies, feeding milestones, TPN duration, CVC use, complications, and hospitalization durations were compared.

RESULTS

Groups were comparable for gestational age, birthweight, obstruction type, and associated anomalies. Time to initiation of enteral feeding was significantly shorter in TAT(+) group (3.01 ± 2.05 vs. 11.1 ± 5.4 days, p = 0.001), as was time to full enteral feeding (7.6 ± 3.8 vs. 19.2 ± 15.6 days, p = 0.002). TPN duration was shorter (6.5 ± 4.1 vs. 19.8 ± 12.4 days, p = 0.019) and CVC insertion rate lower (23.8% vs. 73.3%; p = 0.004) in TAT(+) group. Complication rates were 19% vs. 73.3% (p = 0.002); anastomotic leaks/strictures occurred exclusively in TAT(-) group. Hospitalization was shorter in TAT(+) patients (12.6 ± 4.9 vs. 25.2 ± 21.1 days, p = 0.03).

CONCLUSIONS

TAT placement following CDO repair facilitates earlier enteral feeding, reduces TPN and CVC requirements, decreases complications, and shortens hospitalization. TAT is an effective postoperative nutritional strategy, particularly in high-risk neonates.