Trans anastomotic Feeding in Duodenal Atresia is a Promising Technique to Overcome Prolonged Use of TPN

Introduction: Congenital duodenal atresia is one of the most common intestinal atresia, occurring 1 in 2500-5000 live births. There is massive dilatation of proximal bowel which causes two problems; caliber discrepancy, and hypomotility as it fails to pump intestinal contents across the anastomosis. Transanastomotic feeding offers a practical solution to start early feeding without prolonged TPN.Methods: 20 neonates diagnosed as duodenal atresia, in the Neonatal Surgical Unit of Cairo University Specialized Pediatric Hospital were studied. Cases associated with malrotation, multiple atresia were excluded.In type I atresia we did excision of the web, in type II III we did duodenoduodenostomy, in ten cases there was no transanastomotic tube, in other ten cases transanastomotic tube was inserted. Five cases of them, transanastomotic tube via gastrostomy was left for 1 to 3 weeks, together with nasogastric tube for gastric decompression, in the other 5 cases 2 nasogastric tubes were inserted one transnasal transanastomotic for feeding, the other via mouth for decompression.Results: 20 cases of duodenal atresia were included in this study over 2 years, from January 2012 to January 2014. The average operative time for cases of transanastomotic tube via gastrostomy was 90 minutes while in the cases without it was (50 minutes). The average time needed until full feeds to be achieved was 4-6 days in the transanatomotic feeding group, either through nasogastric tube or gastrostomy, not orally compared to the other group, which was 10 to 20 days orally. In this cohort, no stricture no leakage were found in both groups.Conclusion: Transanastomotic feeding either through gastrostomy or ryle feeding more beneficial for cases with duodenal atresia with massive proximal dilatation. It is a safe and easy technique, and despite being a lengthier operation, feeds could be established earlier.