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Azizoglu M, Kamci TO, Klyuev S, Escolino M, Karakas E, Gigena C, Yuksel S, Bakir AC, Okur MH, Shehata S. Laparoscopic Versus Conventional Open Congenital Duodenal Obstruction Repair: A Systematic Review and Meta-analysis. J Pediatr Surg 2024:161933. [PMID: 39358072 DOI: 10.1016/j.jpedsurg.2024.161933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 08/31/2024] [Accepted: 09/11/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to evaluate the safety and effectiveness of laparoscopic surgery (LS) compared to open surgery (OS) for congenital duodenal obstruction (CDO). METHODS We conducted a literature review to find studies comparing LS and OS in neonates with CDO. A meta-analysis was conducted to systematically compile and compare factors, including surgical duration, time of feeding initiation, hospital length of stay (LOS), and postoperative complications. RESULTS Eleven studies with 1615 patients (LS: 338, OS: 1277) met inclusion criteria. Operative time was observed to be much shorter in the OS group (I2 = 97%); weighted mean difference (WMD) 60.29; 95% confidence interval (CI): 30.29 to 90.28; p < 0.0001). The LS group had a significantly shorter time to initiate feeding (I2 = 0%; WMD -3.38, 95% CI: -4.35 to -2.41; p < 0.00001), shorter time to full feeding (I2 = 0%; WMD -3.64, 95% CI: -5.06 to -2.22; p < 0.00001), and shorter LOS (I2 = 52%; WMD -3.42, 95% CI: -5.75 to -1.08; p = 0.004). There were no significantly differences in the rates of anastomotic leak (I2 = 24%; OR 0.76, 95% CI: 0.12 to 4.67; p = 0.76), anastomotic stricture (I2 = 0%; OR 1.12, 95% CI: 0.39 to 3.20; p = 0.83), postoperative ileus (I2 = 0%; OR 0.60, 95% CI: 0.21 to 1.74; p = 0.34), and overall complications between the groups (I2 = 59%; OR 0.86, 95% CI: 0.42 to 1.74; p = 0.68). The LS group, however, had a significantly decreased frequency of wound infection (I2 = 0%; OR 0.26, 95% CI: 0.08 to 0.82; p = 0.02). CONCLUSION Despite certain limitations in our analysis, the laparoscopic approach was associated with comparable postoperative outcomes. LEVELS OF EVIDENCE 2a. TYPE OF THE STUDY Meta analysis.
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Affiliation(s)
- Mustafa Azizoglu
- Istanbul Esenyurt Hospital, Department of Pediatric Surgery, Istanbul, Turkey; Istinye University Health Science Faculty, Department of Stem Cell and Tissue Engineering, Istanbul, Turkey; Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey.
| | - Tahsin Onat Kamci
- Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey; Dicle University, Department of Pediatric Surgery, Diyarbakir, Turkey
| | - Sergey Klyuev
- Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey; AO GK "MEDSI", Department of Pediatric Surgery, Moscow, Russia
| | - Maria Escolino
- Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey; University of Naples Federico II, Pediatric Surgery Naples, Italy
| | - Esra Karakas
- Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey; Basaksehir Cam and Sakura City Hospital, Department of Pediatric Surgery, Iastanbul, Turkey
| | - Cecilia Gigena
- Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey; Cincinnati Children's, Pediatric Surgery, Cincinnati, OH, USA
| | - Secil Yuksel
- Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey; Basaksehir Cam and Sakura City Hospital, Department of Pediatric Surgery, Iastanbul, Turkey
| | - Ayten Ceren Bakir
- Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey; TC Sağlık Bakanlığı Pendik Eğitim ve Araştırma Hastanesi, Pediatric Surgery, Pendik, İstanbul, Turkey
| | - Mehmet Hanifi Okur
- Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey; Dicle University, Department of Pediatric Surgery, Diyarbakir, Turkey
| | - Sameh Shehata
- Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey; Alexandria University, Pediatric Surgery, Alexandria, Egypt
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Martou L, Saxena AK. Laparoscopic repair of duodenal atresia: systematic review and meta-analysis after consistent implementation of the technique in the past decade. Surg Endosc 2024; 38:3296-3309. [PMID: 38658389 DOI: 10.1007/s00464-024-10828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024]
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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Affiliation(s)
- Laura Martou
- 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
| | - Amulya K Saxena
- 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.
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Cruz-Centeno N, Stewart S, Marlor DR, Aguayo P, Rentea RM, Hendrickson RJ, Juang D, Snyder CL, Fraser JD, St Peter SD, Oyetunji TA. Duodenal Atresia Repair: A Single-Center Comparative Study. Am Surg 2023; 89:5911-5914. [PMID: 37257499 DOI: 10.1177/00031348231180910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The use of laparoscopy in the repair of duodenal atresia has been increasing. However, there is no consensus regarding which surgical approach has better outcomes. We aimed to compare the different surgical approaches and types of anastomoses for duodenal atresia repair. METHODS Patients who underwent duodenal atresia repair at a single pediatric center were identified between January 2006 and June 2022. Those with concomitant gastrointestinal anomalies or who required other simultaneous operations were excluded. The primary outcome was rate of complications, defined as rate of leak, stricture, and re-operation by surgical approach and technique of anastomosis. RESULTS A total of 78 patients were included. The majority were female (51.3%, n = 40), with a median age of 4 days (IQR 3.0,8.0) and a median weight of 2.7 kg (IQR 2.2,3.3) at repair. The re-operation rate was 7.7% (n = 6), of which two were anastomotic leaks, and four were anastomotic strictures. The leak rate was 5.6% (n = 1/18) for the open handsewn and 4.8% (n = 1/21) for the laparoscopic handsewn technique. The stricture rate was 12.5% (n = 1/8) for the laparoscopic-assisted handsewn, 9.1% (n = 2/22) for the laparoscopic U-clip, 4.8% (n = 1/21) for the laparoscopic handsewn, and none with laparoscopic stapled and laparoscopic converted to open handsewn techniques. No differences were found in complication rate when controlling for surgical approach. CONCLUSION The method of surgical approach did not affect the outcomes or complications in the repair of duodenal atresia.
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Affiliation(s)
- Nelimar Cruz-Centeno
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shai Stewart
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Derek R Marlor
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Charles L Snyder
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Jason D Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
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Baran JV, Brown JM, Rivera-Nieves D, Karjoo S, Smithers CJ, Wilsey MJ. Avoiding Surgery: Endoscopic Treatment of Congenital Duodenal Stenosis. JPGN REPORTS 2023; 4:e347. [PMID: 38034463 PMCID: PMC10684216 DOI: 10.1097/pg9.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/24/2023] [Indexed: 12/02/2023]
Abstract
Duodenal stenosis is a rare congenital anomaly that is typically treated surgically, although endoscopic incisional therapy (EIT) and balloon dilation are minimally invasive alternatives. We present a case of a 15-month-old male with vomiting and difficulty tolerating solid food due to severe congenital duodenal stenosis. The patient underwent EIT and serial duodenal dilation to a diameter of 20 mm, which resulted in significant symptom improvement. Intralesional corticosteroid injection (ISI) was administered to help prevent the duodenal septum from restricturing. The combination of EIT, balloon dilation, and ISI was successful in treating the patient's congenital duodenal stenosis and avoided the need for surgery. However, further studies are required to confirm the efficacy of this treatment approach in this patient population. This report highlights the potential of this minimally invasive approach as an alternative to surgical intervention in the management of congenital duodenal stenosis.
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Affiliation(s)
- Jessica V. Baran
- From the Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Jerry M. Brown
- From the Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Desiree Rivera-Nieves
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Sara Karjoo
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - C. Jason Smithers
- Department of Surgery, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Michael J. Wilsey
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
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Pijpers AGH, Eeftinck Schattenkerk LD, de Vries R, Broers CJM, Straver B, van Heurn ELW, Musters GD, Gorter RR, Derikx JPM. Cardiac anomalies in children with congenital duodenal obstruction: a systematic review with meta-analysis. Pediatr Surg Int 2023; 39:160. [PMID: 36967411 PMCID: PMC10040397 DOI: 10.1007/s00383-023-05449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Cardiac anomalies occur frequently in patients with congenital duodenal obstruction (DO). However, the exact occurrence and the type of associated anomalies remain unknown. Therefore, the aim of this systematic review is to aggregate the available literatures on cardiac anomalies in patients with DO. METHODS In July 2022, a search was performed in PubMed and Embase.com. Studies describing cardiac anomalies in patients with congenital DO were considered eligible. Primary outcome was the pooled percentage of cardiac anomalies in patients with DO. Secondary outcomes were the pooled percentages of the types of cardiac anomalies, type of DO, and trisomy 21. A meta-analysis was performed to pool the reported data. RESULTS In total, 99 publications met our eligibility data, representing 6725 patients. The pooled percentage of cardiac anomalies was 29% (95% CI 0.26-0.32). The most common cardiac anomalies were persistent foramen ovale 35% (95% CI 0.20-0.54), ventricular septal defect 33% (95% CI 0.24-0.43), and atrial septal defect 33% (95% CI 0.26-0.41). The most prevalent type of obstruction was type 3 (complete atresias), with a pooled percentage of 54% (95% CI 0.48-0.60). The pooled percentage of Trisomy 21 in patients with DO was 28% (95% CI 0.26-0.31). CONCLUSION This review shows cardiac anomalies are found in one-third of the patients with DO regardless of the presence of trisomy 21. Therefore, we recommend that patients with DO should receive preoperative cardiac screening. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Adinda G H Pijpers
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands.
| | - Laurens D Eeftinck Schattenkerk
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Chantal J M Broers
- Department of Pediatrics, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Bart Straver
- Department of Pediatric Cardiology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ernest L W van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
| | - Gijsbert D Musters
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands
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Zhang J, Xu X, Wang X, Zhao L, Lv Y, Chen K. Laparoscopic versus open repair of congenital duodenal obstruction: a systematic review and meta-analysis. Pediatr Surg Int 2022; 38:1507-1515. [PMID: 36053328 DOI: 10.1007/s00383-022-05209-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the safety and efficacy of laparoscopic versus open repair of congenital duodenal obstruction (CDO), we conducted a systematic review and meta-analysis (CDO). METHODS A literature search was conducted to identify studies that compared laparoscopic surgery (LS) and open surgery (OS) for neonates with CDO. Meta-analysis was used to pool and compare variables such as operative time, time to feeding, length of hospital stay, anastomotic leak or stricture, postoperative ileus, wound infection, and overall postoperative complications. RESULTS Among the 1348 neonatal participants with CDO in the ten studies, 304 received LS and 1044 received OS. When compared to the OS approach, the LS approach resulted in shorter hospital stays, faster time to initial and full feeding, longer operative time, and less wound infection. However, no significant difference in secondary outcomes such as anastomotic leak or stricture, postoperative ileus, and overall postoperative complications was found between LS and OS. CONCLUSIONS LS is a safe, feasible and effective surgical procedure for neonatal CDO when compared to OS. Compared with OS, LS has a faster time to feeding, a shorter hospital stay, and less wound infection. Furthermore, in terms of anastomotic leak or stricture, postoperative ileus, and overall postoperative complications, LS is equivalent to OS. We conclude that LS should be considered an acceptable option for CDO.
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Affiliation(s)
- Jie Zhang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Xiaoqi Xu
- Department of Pediatrics, The Fourth Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, China
| | - Xiaoman Wang
- Department of Pediatrics, The Fourth Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, China
| | - Lingling Zhao
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Yaxin Lv
- Department of Pediatrics, The Fourth Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, China
| | - Kuai Chen
- Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
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Weller JH, Engwall-Gill AJ, Westermann CR, Patel PP, Kunisaki SM, Rhee DS. Laparoscopic Versus Open Surgical Repair of Duodenal Atresia: An NSQIP-Pediatric Analysis. J Surg Res 2022; 279:803-808. [PMID: 35487775 DOI: 10.1016/j.jss.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Laparoscopic repair of duodenal atresia in neonates has gained popularity among some pediatric surgeons. Single-center studies suggest comparable short-term outcomes to open surgery. The purpose of this study was to utilize a large, multi-institutional pediatric dataset to examine 30-day post-operative outcomes by operative approach for newborns who underwent duodenal atresia repairs. METHODS We identified neonates aged ≤1 wk in the 2016-2018 National Surgical Quality Improvement Program-Pediatric -database that underwent a laparoscopic or open repair for duodenal atresia. Preoperative characteristics were compared between operative approaches. Postoperative complications, operative time, postoperative length of stay (LOS), and supplemental nutrition at discharge were assessed using multivariate regressions. RESULTS There were 267 neonates who met inclusion criteria. There were 233 (87%) infants who underwent open repairs and 34 (13%) who underwent laparoscopic repairs. Ten (29%) children who had laparoscopy were converted to open. After adjusting for confounding, laparoscopy was associated with an increase in operative time by 65 min (95% confidence interval 45-87 min, P < 0.001) but a five-day shorter LOS (95% confidence interval -9 to -2, P = 0.006) when compared to laparotomy. There were no significant differences in postoperative complications or supplemental nutrition at discharge. CONCLUSIONS Our findings suggest that laparoscopic repairs of duodenal atresia are associated with shorter postoperative LOS but longer operative times when compared to open repairs. Although the conversion rate to laparotomy remained relatively high, the laparoscopic approach was associated with comparable 30-day postoperative outcomes.
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Affiliation(s)
- Jennine H Weller
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Abigail J Engwall-Gill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Carly R Westermann
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Palak P Patel
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Daniel S Rhee
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland.
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