Duodenal Atresia and Associated Intestinal Atresias: A Systematic Review and Meta-analysis.

Aim of the Study: A critical step in the classical DA repair consists in ruling out the presence of an associated intestinal atresia. Herein, we aimed to investigate: 1. the incidence of DA associated intestinal atresia; 2 the impact of DA surgical approach on outcome when an associated intestinal atresia is present. Methods: Using a defined search strategy, two independent investigators identified studies where patients with DA were reported to have an associated intestinal atresia. Case reports, opinion articles, and grey literature publications were excluded. The study was conducted according to PRISMA guidelines. A meta-analysis was performed using RevMan 5.3 to compare outcomes of open vs. laparoscopic DA repair. Data are expressed as mean±SD or risk ratio with 95% confidence intervals (95%CI). Main Results: Systematic review: Of 840 studies screened, 61 full-text articles were analyzed, and 18 studies (1,886 patients) were included. The incidence of an associated intestinal atresia was 2.5±1.5% (47/1,886 infants, range 0.5-6.7%). The reported incidence of missed intestinal atresias during DA repair was 0.8±2.4% (8/1,028 infants, range 0-9.5%). Meta-analysis: Three comparative retrospective studies (759 infants) were included. Laparoscopic DA repair was associated with a higher risk of missing an associated intestinal atresia (2.9±2.4%, 3/101 infants) than open DA repair (0.3±0.1%, 2/658 infants; p<0.01; risk ratio 8.99, 95%CI: 1.77 to 45.71; I2=0%; Figure). Conclusions: The incidence of associated intestinal atresia in infants with DA is rare, albeit possibly underestimated. Surgeons, especially those performing laparoscopic DA repair, should be aware of the risk of missing an associated intestinal atresia.