Laparoscopic Versus Open Treatment of Congenital Duodenal Obstruction: Multicenter Short-Term Outcomes Analysis

Abstract

Laparoscopic duodenoduodenostomy for congenital duodenal obstruction is a technically challenging procedure with a steep learning curve. Despite a relatively high conversion rate, clinical outcomes remained similar to the traditional open repair in selected patients.

Potential Benefits of Laparoscopic Repair of Duodenal Atresia: Insights from a Retrospective Comparative Study

“…Controversy still exists about the risks and benefits of either approach; only a few studies have directly compared the open versus the MIS technique. [3][4][5][6][7] In our analysis, the overall anesthetic time from induction to transfer out of the operating room was longer in the laparoscopic patients. Significantly, longer surgical procedure times for MIS repair were also found by three out of five comparative reports.…”

“…In our experience, time to full feeding after laparoscopic surgery was clearly shorter than after open surgery; our patients' times to full enteral feeds were similar or even markedly shorter relative to other reports comparing open with MIS CDO repair. 3,[5][6][7] Correspondingly, the duration of PN was also reduced after laparoscopic repair. While PN is known to increase the risk of cholestasis, thrombosis, and the rate of sepsis, 10,11 we were unable to demonstrate a benefit of MIS regarding the occurrence of line infections in our patient cohort.…”

“…Significantly, longer surgical procedure times for MIS repair were also found by three out of five comparative reports. [3][4][5][6][7] Additionally, cardiac comorbidities may have contributed to the prolonged anesthetic duration in some laparoscopic cases.…”

“…2 Only a few reports have directly compared MIS with the traditional open approach; controversy still exists about the value of minimally invasive CDO repair. [3][4][5][6][7] On one hand, the latter may be beneficial in terms of earlier feeding, less postoperative pain, earlier discharge, and better cosmetic outcome. On the other hand, MIS for CDO can be technically challenging and leads to longer procedures than open repair.…”

Evaluation of Three Sources of Validity Evidence for a Laparoscopic Duodenal Atresia Repair Simulator

“…It also has a steep learning curve, as evidenced by higher conversion rates and operative times for surgeons with little or no experience in the laparoscopic approach to DA repair. 1 However, more concerning than the duration of the operation is that early in the evolution of the technique, there were several anecdotal (unpublished) reports of high leak rates. In fact, one center completely abandoned the operation after an unacceptably high leak rate, only to resume the operation several years later, after substantial improvements in technique and skill.…”