W. Svetanoff1, M. C. Mora1, K. A. Diefenbach1 1Nationwide Children’s Hospital, Pediatric Surgery, Columbus, OH, USA
Introduction: Minimally invasive surgery (MIS) has many potential benefits, but its use for repairing neonatal congenital anomalies, such as duodenal atresia (DA), is not yet widely applied. While advantages of a MIS approach include improved visualization, fewer adhesions, and improved cosmetic appearance of the incisions, increased operative times due to the learning curve in utilizing laparoscopy is the main disadvantage. We aimed to compare our single institution outcomes of open versus MIS approach for DA repair over the last nine years.
Methods: A retrospective review of all patients undergoing DA repair from January 2012 to December 2020 was performed. IRB approval was not required as this was part of a larger quality improvement project. Demographic, perioperative, and postoperative variables were collected and compared between patients who underwent open versus MIS repair. Mann-Whitney U test was used to compare continuous variables, while Chi-squared test was used to compare categorical variables.
Results: There were 67 patients total, including 44 in the open group and 23 in the MIS group. While more patients in the MIS group were female (65.2% vs 38.6%, p=0.04), there was no difference in ethnicity (78.3% vs 65.9%, p=0.30), congenital heart disease (39.1% vs 34.1%, p=0.69), presence of Trisomy 21 (30.4% vs 40.9%, p=0.40), or weight at time of surgery (2.4 kilograms (IQR 1.9, 2.8) vs 2.6 kilograms (2.0, 3.0), p=0.10)) compared to the open cohort. The median operative time was significantly longer in the MIS group (183 min (IQR 148, 203) vs 128.5 min (IQR 101.5, 150.3), p<0.001) compared to the open group. While the length of stay was 14 days shorter in the MIS group, this did not reach statistical significance.
Postoperatively, the total complication rate (27.3% vs 4.3%, p=0.025) and reoperation rate (22.7% vs 4.3%, p=0.05) were significantly higher in the open group compared to the MIS group, respectively (Table 1). There was one mortality in each group; both patients required a reoperation for stricture/leak but ultimately succumbed to other congenital comorbidities.
Conclusion: Performance of duodenal atresia repair through a minimally invasive approach can be performed safely, with fewer complications, and decreased risk of reoperation compared to an open approach. While a learning curve leading to longer operative times has been recognized, this time difference was less than an hour and may be offset by advantages in postoperative outcomes.
