Duodenal atresia and associated intestinal atresia: a cohort study and review of the literature
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.
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.
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).
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.
KeywordsJejunal atresia Ileal atresia Cohort study Systematic review Meta-analysis
This study was not funded by any grant.
Compliance with ethical standards
Conflict of interest
Authors have no potential conflicts of interest for this study.
Ethical approval REB #1000055682. Not applicable in the Systematic Review and Meta-Analysis.
Not applicable, since the study was a review of the medical charts of patients, plus a Systematic Review and Meta-Analysis.
- 8.Rattan KN, Singh J, Dalal P (2016) Neonatal duodenal obstruction: a 15-year experience. J Neonatal Surg 5:13Google Scholar
- 20.Gray SW, Skandalakis JE (1972) Embryology for surgeons: the embryological basis for treatment of congenitaldefects. WB Saunders, Philadelphia, pp 177–217Google Scholar
- 23.PROSPERO International Prospective Register of Systematic Reviews. http://www.crd.york.ac.uk/prospero/about.php?about=about. Accessed 15th Apr 2018
- 24.Review Manager (RevMan). 5.3. (2014) The Nordic Cochrane Centre, The Cochrane Collaboration, CopenhagenGoogle Scholar
- 32.Rao KL, Chowdhary SK, Suri S et al (2001) Duodenal atresia: outcome analysis from a regional neonatal center. Indian Pediatr 38:1277–1280Google Scholar
- 33.Sarin YK, Sharma A, Sinha S et al (2012) Duodenal webs: an experience with 18 patients. J Neonatal Surg 1:20Google Scholar