Role of Transanastomotic Feeding Tube versus Early Gastric Feeding in Postoperative Duodenal Surgery

Background: Postoperative enteral feeding in congenital duodenal obstruction is usually delayed due to dilated atonic duodenum. The trans-anastomotic tube feeding (TAT) has been proposed to be more effective than early gastric feeding in the role of supporting “Enhanced recovery after surgery concept”. Objective: Comparing time to feeding among patients using TAT, early gastric feeding, and traditional delayed gastric feeding. Materials and Methods: Comparing postoperative enteric feeding via TAT (group A: n=7) and gastric feeding (group B: n=6) — prospective data collected from 2015 to 2020 — to traditional gastric feeding (group C: n=17) that is retrospective data from 2008 to 2015, in neonates with congenital duodenal obstruction. Results: TAT and early gastric (OG) feedings had provided earlier enteral feeding compared to traditional practice (p<0.001). The early gastric feeding was faster full fed than TAT on the earlier postoperative date with median (IQR) = 11 (10, 11) and 16 (13, 23) respectively. However, all 3 groups had the same timing of gastric full feeding (median (IQR): A=8 (5, 11); B=7 (4, 7); C=9 (5, 10)), p=0.772. Even not significant, the early gastric feeding group provided the shorter time of hospital stay and TPN administration. Conclusion: The early OG feeding is feasible for early postoperative feeding comparable to TAT feeding and applicable in cases beware of TAT-related complications. Postoperative gastric function recovery is not related to the pre- or post-anastomotic feeding. Keywords: Duodenal atresia; Duodenal stenosis; Neonatal duodenal obstruction; Trans-anastomotic feeding tube; Enteral feeding; ERAS