Is laparoscopic surgery better than open surgery for the repair of congenital duodenal obstruction? A review of the current evidences

Infographic · Oct 2018 · 1 min read

In brief

This systematic review of 180 patients found no significant differences between laparoscopic and open repair of congenital duodenal obstruction in operative time, recovery metrics, or hospital stay. While laparoscopic approach is feasible, surgeons must remain vigilant for distal pathology that may be missed during minimally invasive repair.

Laparoscopic and open repair of congenital duodenal obstruction show no significant differences in operative time, feeding tolerance, or length of stay
Anastomotic complication rates are low in both approaches (4.4% laparoscopic vs 1.8% open) based on limited retrospective data
Two cases of missed distal pathology occurred with laparoscopy—surgeons must carefully evaluate the entire bowel during repair
Laparoscopic CDO repair is feasible and safe when performed by experienced surgeons, but larger studies are needed to determine superiority
Current evidence from 180 patients across 4 studies is insufficient to definitively recommend one approach over the other

Written by the GCMD Library team from the infographic.

The infographic uses a split-screen layout with a teal-colored column on the left representing laparoscopic surgery (marked with scissors icon) and a white column on the right representing open surgery (marked with scalpel icon). Data from four retrospective cohort studies involving 180 patients is presented in three rows comparing complication rates between the two surgical approaches.

Background/purpose

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.

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