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Duodenal atresia and associated intestinal atresia: a cohort study and review of the literature

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Abstract

Purpose

To determine the true incidence of associated intestinal atresia (AIA) in infants with duodenal atresia (DA) and to analyze whether the surgical approach, open versus laparoscopic, would impact on patient outcome when AIA is present.

Methods

Cohort study We review all DA infants treated at our institution (2001–2016) and analyzed the outcome of those with AIA. Systematic review/meta-analysis Using a defined search strategy and according to PRISMA guidelines, two investigators independently identified all studies on DA and searched cases of AIA to determine its incidence. Data are mean ± SD.

Results

Cohort study Of 140 DA infants, 10 (7%) had AIA (4 type I, 4 type III, 2 type II). All type I AIA (webs) were found in the duodenum. Systematic review/meta-analysis Of 840 studies, 18 were included (2026 infants). The incidence of AIA was 2.8 ± 1.6%. The incidence of missed AIA was 0.8 ± 2.4%. Three comparative studies (759 infants) showed higher risk of missed AIA following laparoscopic (2.9 ± 2.4%) than open repair (0.3 ± 0.1%; p < 0.01).

Conclusions

The incidence of AIA in DA infants is low and the risk of missing it is higher at laparoscopy than at laparotomy. Regardless the approach, surgeons should carefully investigate bowel continuity to avoid the risk of missing AIA.

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Funding

This study was not funded by any grant.

Author information

Authors and Affiliations

  1. Division of General and Thoracic Surgery, The Hospital for Sick Children, 1524C-555 University Ave, Toronto, ON, M5G 1X8, Canada

    Maria Enrica Miscia & Augusto Zani

  2. Department of Pediatric Surgery, “Spirito Santo” Hospital, Pescara, Italy

    Maria Enrica Miscia, Giuseppe Lauriti & Pierluigi Lelli Chiesa

  3. “G. d’Annunzio” University, Chieti-Pescara, Chieti, Italy

    Maria Enrica Miscia, Giuseppe Lauriti & Pierluigi Lelli Chiesa

Authors
  1. Maria Enrica Miscia
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  2. Giuseppe Lauriti
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  3. Pierluigi Lelli Chiesa
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  4. Augusto Zani
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Corresponding author

Correspondence to Augusto Zani.

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Conflict of interest

Authors have no potential conflicts of interest for this study.

Ethical approval

Ethical approval REB #1000055682. Not applicable in the Systematic Review and Meta-Analysis.

Informed consent

Not applicable, since the study was a review of the medical charts of patients, plus a Systematic Review and Meta-Analysis.

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Miscia, M.E., Lauriti, G., Lelli Chiesa, P. et al. Duodenal atresia and associated intestinal atresia: a cohort study and review of the literature. Pediatr Surg Int 35, 151–157 (2019). https://doi.org/10.1007/s00383-018-4387-1

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  • DOI: https://doi.org/10.1007/s00383-018-4387-1

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