Laparoscopic versus conventional open congenital duodenal obstruction repair: a systematic review and meta‐analysis

M Azizoğlu*, TO Kamçı**, S Klyuev***, M Escolino****, E Karakaş*****, C Gigena******, S Yuksel*******, AC Bakır********, MH Okur*********, S Shehata**********

*Istanbul Esenyurt Hospital, Department of Pediatric Surgery, Istanbul, Turkey. Istinye University Health Science Faculty, Department of Stem Cell and Tissue Engineering, Istanbul, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turke
**Dicle Unviersity Department of Pediatric Surgery, Diyarbakir, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
***AO GK "MEDSI", Department of Pediatric Surgery, Moscow, Russia Federation. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
****University of Naples Federico II, Pediatric Surgery Naples, Italy. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
*****Basaksehir Cam and Sakura City Hospital Department of Pediatric Surgery, Istanbul, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
******Cincinnati Children's, Pediatric Surgery, Cincinnati, OH, USA. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
*******Istanbul Basaksehir Cam and Sakura City Hospital, Pediatric Surgery Clinic
********TC Sağlık Bakanlığı Pendik Eğitim ve Araştırma Hastanesi, Pediatric Surgery, Pendik, İstanbul, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
*********Dicle University Department of Pediatric Surgery, Diyarbakir, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
**********Alexandria University, Pediatric Surgery, Alexandria, Egypt. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey

Aim

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).

Method

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.

Keywords: Congenital duodenal obstruction, laparoscopic surgery, open surgery

Konjenital duodenal obstrüksiyonda laparoskopik cerrahi ile açık cerrahi karşılaştırması: sistematik derleme ve meta-analiz

M Azizoğlu*, TO Kamçı**, S Klyuev***, M Escolino****, E Karakaş*****, C Gigena******, S Yuksel*******, AC Bakır********, MH Okur*********, S Shehata**********

*Istanbul Esenyurt Hospital, Department of Pediatric Surgery, Istanbul, Turkey. Istinye University Health Science Faculty, Department of Stem Cell and Tissue Engineering, Istanbul, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turke
**Dicle Unviersity Department of Pediatric Surgery, Diyarbakir, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
***AO GK "MEDSI", Department of Pediatric Surgery, Moscow, Russia Federation. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
****University of Naples Federico II, Pediatric Surgery Naples, Italy. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
*****Basaksehir Cam and Sakura City Hospital Department of Pediatric Surgery, Istanbul, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
******Cincinnati Children's, Pediatric Surgery, Cincinnati, OH, USA. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
*******İstanbul Başakşehir Çam ve Sakura Şehir Hastanesi, Çocuk Cerrahi Kliniği
********TC Sağlık Bakanlığı Pendik Eğitim ve Araştırma Hastanesi, Pediatric Surgery, Pendik, İstanbul, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
*********Dicle University Department of Pediatric Surgery, Diyarbakir, Turkey. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey
**********Alexandria University, Pediatric Surgery, Alexandria, Egypt. Pediatric Surgery Meta Analysis Group (PESMA), Istanbul, Turkey

Amaç

Konjenital duodenal obstrüksiyon (KDO) tedavisinde laparoskopik cerrahi (LS) ile açık cerrahinin (OS) güvenlik ve etkinliğini değerlendirmek amacıyla sistematik bir derleme ve meta-analiz gerçekleştirdik.

Yöntem

KDO'lu yenidoğanlarda LS ve OS'yi karşılaştıran çalışmaları bulmak için bir literatür taraması yaptık. Cerrahi süresi, beslenmeye başlama süresi, hastanede kalış süresi (LOS) ve postoperatif komplikasyonlar gibi faktörleri sistematik olarak derlemek ve karşılaştırmak için bir meta-analiz yapıldı.

Bulgular

Kapsama kriterlerini karşılayan 1615 hasta (LS: 338, OS: 1277) ile 11 çalışma bulundu. Cerrahi sürenin OS grubunda çok daha kısa olduğu gözlemlendi (I²=97%) (WMD) 60.29; %95 güven aralığı (CI): 30.29 ile 90.28; p<0.0001). LS grubunda ise beslenmeye başlama süresi (I²=0%; WMD -3.38, %95 CI: -4.35 ile -2.41; p<0.00001), tam beslenmeye geçiş süresi (I²=0%; WMD -3.64, %95 CI: -5.06 ile -2.22; p<0.00001) ve LOS (I²=52%; WMD -3.42, %95 CI: -5.75 ile -1.08; p=0.004) anlamlı olarak daha kısa bulundu. Gruplar arasında anastomoz kaçak oranı (I²=24%; OR 0.76, %95 CI: 0.12 ile 4.67; p=0.76), anastomoz darlığı (I²=0%; OR 1.12, %95 CI: 0.39 ile 3.20; p=0.83), postoperatif ileus (I²=0%; OR 0.60, %95 CI: 0.21 ile 1.74; p=0.34) ve genel komplikasyon oranlarında anlamlı bir fark bulunmadı (I²=59%; OR 0.86, %95 CI: 0.42 ile 1.74; p=0.68). Ancak, LS grubunda yara enfeksiyonu sıklığı anlamlı olarak daha düşük bulundu (I²=0%; OR 0.26, %95 CI: 0.08 ile 0.82; p=0.02).

Sonuç

Analizimizdeki bazı sınırlamalara rağmen, laparoskopik yaklaşımın karşılaştırılabilir postoperatif sonuçlarla ilişkili olduğu tespit edildi.

Anahtar Kelimeler: Konjenital duodenal obstrüksiyon, laparoskopik cerrahi, açık cerrahi