Early versus late duodenal atresia repair in preterm and low birth weight neonates

Abstract

Aims
Duodenal atresia (DA) is a common cause of neonatal intestinal obstruction requiring surgical correction. The timing of repair in very low birth weight (VLBW, <1.5 kg) and extremely preterm (<32 weeks gestation) neonates remains debated. Early repair may reduce total parenteral nutrition (TPN)-associated morbidity, whereas delayed repair may mitigate anaesthetic and technical risks in fragile neonates.

Methods
A retrospective 20-year review (2004–2024) was conducted at a tertiary paediatric surgical centre. Infants <1.5 kg and/or <32 weeks were classified as early repair (≤14 days) or delayed repair (>14 days). Outcomes included postoperative complications, time to full enteral feeding, hospital stay, and mortality.

Results
Sixteen infants met inclusion criteria. Of these, 7 (43.8%) underwent early repair and 9 (56.2%) underwent delayed repair. There were no significant differences in comorbidities or overall complication rates between groups. Time to full feeds was shorter in the early repair group (median 11 vs 40 days, p = 0.013). No surgery-related deaths occurred (0 [0%] in both groups).

Discussion
Early repair of DA in stable preterm or VLBW infants is feasible and safe when undertaken by experienced teams. Surgical timing should be guided by physiological stability rather than arbitrary gestational or weight thresholds. Further studies are needed to refine evidence-based guidelines.