Minimal Invasive Duodenal Atresia Repair - Does Surgical Technique of Anastomosis Matter? A Systematic Review and Meta-analysis.

Introduction: Minimally invasive repair of duodenal atresia has gained widespread popularity since its introduction in 2001. While the diamond-shaped (DS) anastomosis is considered the gold standard in open surgery and superior to the side-to-side (SS) anastomosis, the SS anastomosis has regained popularity in minimally invasive repairs of duodenal atresia. To date, no comprehensive review has assessed the impact of anastomotic technique on outcomes in minimally invasive duodenal atresia repair. This systematic review evaluates the impact of DS versus SS anastomosis on complications and outcomes in laparoscopic duodenal atresia repair.

Methods: A comprehensive literature search was conducted from January 2001 to December 2024 across PubMed, EMBASE, and Web of Science to identify studies reporting on minimally invasive duodenal atresia repair with hand-sewn anastomosis. Thirteen studies, including 288 patients (159 DS, 129 SS), were included. Primary outcomes analyzed included operative time, conversion rate, time to feeding, and length of hospital stay. Secondary outcomes focused on postoperative complications, including anastomotic leaks and strictures. Statistical analyses were performed using Mann-Whitney U tests and Fisher's exact tests.

Results: No significant differences were found between DS and SS with regard to operative time, time to initial or full feeding, or hospital stay. The DS group had a higher conversion rate (11 % vs. 3 %, p = 0.01), but no significant difference was observed in overall complications, stricture rates, or time to feeding. Notably, the DS group had a significantly higher incidence of anastomotic leakage (p = 0.03), primarily driven by a single study. The leakage rate was lower in studies using a continuous running suture for the DS anastomosis.

Conclusion: In laparoscopic duodenal atresia repair, the SS anastomosis is not inferior to the DS technique in terms of operative time, hospital stay, or feeding outcomes. The DS technique carries a higher risk of anastomotic leakage, which can be mitigated with the use of a continuous suture technique. Both techniques are equally safe for minimally invasive duodenal atresia repair, suggesting that SS offers a viable alternative to DS.

Level of evidence: IV.