Is laparoscopic surgery better than open surgery for the repair of congenital duodenal obstruction? A review of the current evidences.
OBJECTIVE
Whether laparoscopic surgery is superior to open surgery in the repair of congenital duodenal obstruction remains controversial. The objective of this study is to systematically review the literatures, which compare the outcomes of these two operative approaches.


METHODS
A systematic review of the studies comparing these two surgical approaches since 2000 was carried out.


RESULTS
Four retrospective cohort studies comprising 180 patients were eligible for analysis. Duodenal atresia was the most common diagnosis (62.3%). Overall, there were no statistically significant differences in terms of operative duration (SMD: 0.75, 95% CI: 0.46-1.04), ventilator dependence (SMD: 0.04, 95% CI: -0.22 to 0.29), time to initial enteral feeding (SMD: 0.12, 95% CI: -0.14 to 0.38), time to full enteral feeding (SMD: 0.18, 95% CI: -0.15 to 0.50) and hospital stay (SMD: -0.03, 95% CI: -0.29 to 0.22). The overall incidences of anastomotic complications in laparoscopic vs open groups were 4.4% vs 1.8%. Two cases of missed distal pathology were reported in the laparoscopic group.


CONCLUSIONS
Laparoscopic surgery is feasible in the repair of CDO. Study with larger sample size is needed for further analysis to examine whether open or laparoscopic approach is superior. Meanwhile, it is still safe to practice laparoscopic repair of CDO in skilled surgeons, with attention to the possibility of distal pathology.
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong.
Patrick Ho Yu
PH
Chung
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong.
Carol Wing Yan
CW
Wong
School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong.
Dennis Kai Ming
DK
Ip
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong.
Paul Kwong Hang
PK
Tam
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong. Electronic address: kkywong@hku.hk.
Kenneth Kak Yuen
KK
Wong
D000714:Anastomosis, Surgical / Q000009:adverse effects; D004380:Duodenal Obstruction / Q000151:congenital / Q000601:surgery*; D004386:Duodenum / Q000002:abnormalities; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing
Congenital duodenal obstruction; Duodenal atresia; Duodenoduodenostomy; Laparoscopy; Neonatal surgery