Laparoscopic Versus Conventional Open Congenital Duodenal Obstruction Repair: A Systematic Review and Meta-analysis

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.

Keywords: Congenital duodenal obstruction; Laparoscopic surgery; Open surgery.