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Laparoscopic repair of duodenal atresia: systematic review and meta-analysis after consistent implementation of the technique in the past decade

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Abstract

Background

Laparoscopic repair of duodenal atresia (LRDA) remains a technically challenging procedure and its benefits ambiguous. To assess the safety and efficacy of LRDA, we performed a systematic review of techniques and material for LRDA and a meta-analysis comparing outcomes with open repair (OR).

Methods

Comprehensive search of EMBASSE, PubMed and Cochrane was performed from 2000 to 2023. Studies comparing LRDA with OR were identified and outcomes extracted included operative time, time to enteral feeds, length of hospitalisation, anastomotic leaks and stricture and total complications. χ2 was used to assess associations between complications and conversions rates of different LRDA approaches (laparoscopic technique, suturing technique). Comprehensive meta-analysis was used for Meta-analysis.

Results

Twelve studies were identified and 1731 patients were enrolled in the study (398 [LRDA] and 1325 [OR]). Total rate of complications and conversion for LRDA was 15.58% and 18.84%, respectively. Complication rates were not significantly affected by operative technique and suturing technique. Conversion rates were not significantly affected operative technique; using a combination of interrupted and running suturing was significantly higher than using running or interrupted (χ2 = 7.45, p < 0.05). Anastomotic leaks, strictures and total complications were equivocal between LRDA and OR (OR 1.672, 95% CI 0.796–3.514; OR 2.010, 95% CI 0.758–5.333; OR 1.172, 95% CI 0.195–7.03). Operative time was significantly greater for LRDA (SDM 1.035, 95% CI 0.574–1.495, p < 0.001). Time to initial and full enteral feeds and length of hospitalisation were shorter in the LRDA group (SDM − 0.493, 95% CI − 2.166 to 1.752, p = 0.466; SDM − 0.207, 95% CI − 1.807 to 0.822, p = 0.019; SDM − 0.111, 95% CI − 1.101 to 0.880, p = 0.466, respectively).

Conclusions

LRDA showed equivalent complication rates compared to OR with an additional benefit of quicker establishment of feeds. There was no significant difference in complication and conversion rates between laparoscopic techniques. Despite a longer operative time, LRDA provides a safe minimal access approach for neonates after this consistent implementation of the technique in the past decade.

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References

  1. Bethell GS, Long A-M, Knight M, Hall NJ (2020) Congenital duodenal obstruction in the UK: a population-based study. Arch Dis Child 105:178–183

    Article  Google Scholar 

  2. Kimura K, Mukohara N, Nishijima E, Muraji T, Tsugawa C, Matsumoto Y (1990) Diamond-shaped anastomosis for duodenal atresia: an experience with 44 patients over 15 years. J Pediatr Surg 25:977–979

    Article  CAS  PubMed  Google Scholar 

  3. Gracie DJ, Lam JPH (2023) Laparoscopic duodenoduodenostomy: local experience, outcomes and points of practice. J Ped Endosc Surg 5:7–11

    Article  Google Scholar 

  4. Bax NM, Ure BM, van der Zee DC, van Tuijl I (2001) Laparoscopic duodenoduodenostomy for duodenal atresia. Surg Endosc 15:217

    CAS  PubMed  Google Scholar 

  5. van der Zee DC (2011) Laparoscopic repair of duodenal atresia: revisited. World J Surg 35:1781–1784

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zhang J, Xu X, Wang X, Zhao L, Lv Y, Chen K (2022) Laparoscopic versus open repair of congenital duodenal obstruction: a systematic review and meta-analysis. Pediatr Surg Int 38:1507–1515

    Article  PubMed  Google Scholar 

  7. Mentessidou A, Saxena AK (2017) Laparoscopic repair of duodenal atresia: systematic review and meta-analysis. World J Surg 41:2178–2184

    Article  PubMed  Google Scholar 

  8. Sterne JA, Hernán MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135

    Article  PubMed  PubMed Central  Google Scholar 

  10. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed  PubMed Central  Google Scholar 

  11. Spilde TL, St Peter SD, Keckler SJ, Holcomb GW, Snyder CL, Ostlie DJ (2008) Open vs laparoscopic repair of congenital duodenal obstructions: a concurrent series. J Pediatr Surg 43:1002–1005

    Article  PubMed  Google Scholar 

  12. Cruz-Centeno N, Stewart S, Marlor DR et al (2023) Duodenal atresia repair: a single-center comparative study. Am Surg 89:5911–5914

    Article  PubMed  Google Scholar 

  13. Weller JH, Engwall-Gill AJ, Westermann CR, Patel PP, Kunisaki SM, Rhee DS (2022) Laparoscopic versus open surgical repair of duodenal atresia: a NSQIP-pediatric analysis. J Surg Res 279:803–808

    Article  PubMed  Google Scholar 

  14. Williams SA, Nguyen ATH, Chang H, Danielson PD, Chandler NM (2022) Multicenter comparison of laparoscopic versus open repair of duodenal atresia in neonates. J Laparoendosc Adv Surg Tech A 32:226–230

    Article  PubMed  Google Scholar 

  15. Sidler M, Djendov F, Curry JI, Blackburn S, Giuliani S, Eaton S, Mullassery D, Cross KM, De Coppi P (2020) Potential benefits of laparoscopic repair of duodenal atresia: insights from a retrospective comparative study. Eur J Pediatr Surg 30:33–38

    Article  PubMed  Google Scholar 

  16. Holler A-S, Muensterer OJ, Martynov I, Gianicolo EA, Lacher M, Zimmermann P (2019) Duodenal atresia repair using a miniature stapler compared to laparoscopic hand-sewn and open technique. J Laparoendosc Adv Surg Tech 29:1216–1222

    Article  Google Scholar 

  17. Gfroerer S, Theilen T-M, Fiegel HC, Rolle U (2018) Laparoscopic versus open surgery for the repair of congenital duodenal obstructions in infants and children. Surg Endosc 32:3909–3917

    Article  PubMed  Google Scholar 

  18. Cho MJ, Kim DY, Kim SC, Namgoong JM (2017) Transition from laparotomy to laparoscopic repair of congenital duodenal obstruction in neonates: our early experience. Front Pediatr 5:203

    Article  PubMed  PubMed Central  Google Scholar 

  19. Son TN, Kien HH (2017) Laparoscopic versus open surgery in management of congenital duodenal obstruction in neonates: a single-center experience with 112 cases. J Pediatr Surg 52:1949–1951

    Article  PubMed  Google Scholar 

  20. Parmentier B, Peycelon M, Muller C-O, El Ghoneimi A, Bonnard A (2015) Laparoscopic management of congenital duodenal atresia or stenosis: a single-center early experience. J Pediatr Surg 50:1833–1836

    Article  PubMed  Google Scholar 

  21. Jensen AR, Short SS, Anselmo DM, Torres MB, Frykman PK, Shin CE, Wang K, Nguyen NX (2013) Laparoscopic versus open treatment of congenital duodenal obstruction: multicenter short-term outcomes analysis. J Laparoendosc Adv Surg Tech 23:876–880

    Article  Google Scholar 

  22. Hill S, Koontz CS, Langness SM, Wulkan ML (2011) Laparoscopic versus open repair of congenital duodenal obstruction in infants. J Laparoendosc Adv Surg Tech A 21:961–963

    Article  PubMed  Google Scholar 

  23. Miscia ME, Lauriti G, Lelli Chiesa P, Zani A (2019) Duodenal atresia and associated intestinal atresia: a cohort study and review of the literature. Pediatr Surg Int 35:151–157

    Article  PubMed  Google Scholar 

  24. Hasegawa T, Takano S, Masuda K, Fujiwara Y, Miyahara A, Miura M (2023) Retrospective analysis of neonatal surgery at Tottori University over the past ten years. Yonago Acta Med 66:413–421

    Article  PubMed  PubMed Central  Google Scholar 

  25. Liang Z, Lan M, Xu X, Liu F, Tao B, Zeng J (2023) Diamond-shaped versus side-to-side anastomotic duodenoduodenostomy in laparoscopic management of annular pancreas in children: a single-center retrospective comparative study. Transl Pediatr 12(10):1791–1799. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644016/. Accessed 2 Dec 2023

    Article  PubMed  PubMed Central  Google Scholar 

  26. Oh C, Lee S, Lee S-K, Seo J-M (2017) Laparoscopic duodenoduodenostomy with parallel anastomosis for duodenal atresia. Surg Endosc 31:2406–2410

    Article  PubMed  Google Scholar 

  27. Valusek PA, Spilde TL, Tsao K, St Peter SD, Holcomb GW, Ostlie DJ (2007) Laparoscopic duodenal atresia repair using surgical U-clips: a novel technique. Surg Endosc 21:1023–1024

    Article  PubMed  Google Scholar 

  28. Fujii T, Tanaka A, Katami H, Shimono R (2021) Stapled versus hand-sewn intestinal anastomosis in pediatric patients: a systematic review and meta-analysis. BMC Pediatr 21:435

    Article  PubMed  PubMed Central  Google Scholar 

  29. Westwood E, Saxena AK (2022) Pitfalls in laparoscopic duodenal atresia repair requiring modifications in approach based on literature review. J Ped Endosc Surg 4:13–16

    Article  Google Scholar 

  30. Etlinger P, Barroso C, Miranda A et al (2022) Characterization of technical skill progress in a standardized rabbit model for training in laparoscopic duodenal atresia repair. Surg Endosc 36:2456–2465

    Article  PubMed  Google Scholar 

  31. Guelfand M, Harding C (2021) Laparoscopic management of congenital intestinal obstruction: duodenal atresia and small bowel atresia. J Laparoendosc Adv Surg Tech A 31:1185–1194

    Article  PubMed  Google Scholar 

  32. Marcadis AR, Romain CV, Alkhoury F (2019) Robotic duodeno-duodenostomy creation in a pediatric patient with idiopathic duodenal stricture. J Robotic Surg 13:695–698

    Article  Google Scholar 

  33. Sanders RD, Davidson A (2009) Anesthetic-induced neurotoxicity of the neonate: time for clinical guidelines? Paediatr Anaesth 19:1141–1146

    Article  PubMed  Google Scholar 

  34. Hall NJ, Kitteringham L, Ron O, Stedman F, Stanton M, Wheeler R, Jones C, Smyth R, Keys C (2023) A minimally interventional approach to oesophageal atresia repair with early enteral feeding is safe, optimises neonatal outcomes, and reduces resource use. J Pediatr Surg S0022–3468(23):00563–00568

    Google Scholar 

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Authors and Affiliations

  1. Department of Paediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK

    Laura Martou & Amulya K. Saxena

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  1. Laura Martou
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  2. Amulya K. Saxena
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Correspondence to Amulya K. Saxena.

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Laura Martou and Amulya Kumar Saxena have no conflicts of interest or financial ties to disclose.

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Martou, L., Saxena, A.K. Laparoscopic repair of duodenal atresia: systematic review and meta-analysis after consistent implementation of the technique in the past decade. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10828-5

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