Laparoscopic Stapled Anastomosis for Duodenal Atresia: Superior Efficiency Compared to Hand-Sewn Techniques

At our institution, repair of congenital duodenal obstruction has been performed via three techniques: open hand-sewn anastomosis (OHSA), laparoscopic hand-sewn anastomosis (LHSA) or more recently, laparoscopic stapled anastomosis (LSA). We aim to compare perioperative outcomes and complications among these techniques.

A retrospective review was conducted on patients who underwent duodenoduodenostomy (DD) or duodenojejunostomy (DJ) via these three techniques between January 2014 and November 2024. Our primary outcome was anastomotic complications. Secondary outcomes included post-operative length of stay (LOS), time to initiation of feeds, and operative time. Operative time analysis excluded patients undergoing additional procedures. Patients with complex comorbidities extending hospitalization were excluded from LOS analysis.

A total of 27 patients were identified: 11 OHSA (7 DD, 4 DJ), 4 LHSA (3 DD, 1 DJ), 12 LSA (10 DD, 2 DJ). Two patients who underwent DD via OHSA had anastomotic complications (1 leak, 1 stenosis). No patients had anastomotic complications in the LHSA and LSA groups. Operative times were longer for LHSA (median 118 min) compared to LSA (84.5 min, p = 0.047). There was no significant difference in operative time between OHSA and LSA. No significant differences were observed in LOS or time to initiation of feeds between the three groups.

LSA was associated with shorter operative time than LHSA and no observed anastomotic complications; however, given the limited sample size and retrospective nature of the study, further research is needed to confirm these findings. LSA represents a feasible and efficient approach for CDO repair.