Minimal Change in Minimally Invasive Surgery: National Trends in Laparoscopic Duodenal Atresia Repair, 2016-2024.

Abstract

Background: Laparoscopic duodenal atresia repair in neonates, introduced over two decades ago, is associated with select short-term benefits versus open repair, but recent U.S. population-level data are lacking. We evaluated national trends and compared operative time and outcomes.

Methods: A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program Pediatric database from 2016 to 2024 of neonates (≤28 days) undergoing duodenal atresia repair was conducted to assess the annual proportion of laparoscopic versus open repairs (primary outcome) and length of stay (LOS), shortened LOS (≤13 days), composite 30-day morbidity (death, reoperation, prolonged ventilation, transfusion, and surgical site infection), and operative time (secondary outcomes). Temporal trends were assessed using logistic regression. Outcomes were compared using multivariable regression adjusting for patient characteristics.

Results: Among 1407 neonates, 241 (17.1%) underwent laparoscopic or converted repair and 1,166 (82.9%) open repair. Laparoscopic utilization increased from 13.6% in 2016 to 18.3% in 2024 (adjusted odds ratio [aOR]: 1.10 per year, 95% CI: 1.03-1.17). Patients undergoing laparoscopic repair had higher birth weight (median 2.63 versus 2.47 kg, P < .001). In adjusted analyses, laparoscopic repair was associated with shorter LOS (geometric mean ratio 0.93, 95% CI: 0.88-0.99), higher odds of shortened LOS (aOR: 1.90, 95% CI: 1.10-3.28), lower composite morbidity (aOR: 0.61, 95% CI: 0.38-0.99), and longer operative time (+41.7 minutes, 95% CI: 31.7-51.8).

Conclusions: Laparoscopic repair was associated with shorter LOS and lower morbidity, yet adoption remains low. Longer operative time and preferential use in larger neonates suggest potential technical barriers to adoption, which are potentially modifiable.