Small bowel duplication cyst in the pediatric population—when to operate?

Aim: Introduction: The aim of the study is to determine the optimal timing for surgery in patients with small bowel duplications. Methods: A retrospective cohort study, including all patients younger than 18 years who were diagnosed with small bowel duplications from 2013 until 2024 in a single tertiary medical center, was performed. Patients’ demographics, duplication size and location, pathological results, and clinical outcomes were collected. Results: Sixteen patients (nine boys, seven girls) underwent laparoscopic-assisted resection of small bowel duplication at an average age of 3 years. A prenatal diagnosis was made in 11 patients, 10 (91%) of whom underwent elective surgery at a median age of 1.3 years. Overall, six patients required semi-elective or urgent surgery due to bowel obstruction, abdominal discomfort, or symptomatic anemia, with most (83%) lacking prenatal evaluation. Elective surgery patients had significantly smaller duplications (13 cm³ vs. 135 cm³). Post-operative recovery was satisfactory in all patients, with an average hospital stay of 6 days. Conclusion: In conclusion, asymptomatic, small duplication cysts in the small bowel of pediatric patients can be managed expectantly and can be operated after the first year of age. This approach is safe and allows for laparoscopic exploration in older infants, yielding satisfactory outcomes.