Tapering enteroplasty shows no significant difference in postoperative outcomes compared to primary anastomosisTapering Enteroplasty Shows No Clear Benefit for Bowel Atresia

PURPOSE: Small bowel atresia (SBA) affects approximately 1 in 1,500-4,500 neonates and represents one of the most common congenital causes of intestinal obstruction. Management of the characteristically dilated proximal bowel segment, whether by tapering enteroplasty (TAP) or primary anastomosis without caliber reduction (non-TAP), has remained controversial for five decades in the absence of randomized evidence. We conducted a systematic review and meta-analysis to systematically synthesize comparative evidence on postoperative outcomes following TAP versus non-TAP in neonatal SBA. METHODS: A PRISMA 2020-compliant systematic review and meta-analysis (PROSPERO: CRD420261329962) searched MEDLINE, Embase, Scopus, and Cochrane from inception through April 2026. Pooled risk ratios (RR) and mean differences (MD) were computed using DerSimonian-Laird random-effects models. Leave-one-out sensitivity analyses were performed for all outcomes. RESULTS: Six retrospective cohort studies (n = 278 neonates; TAP: 72, non-TAP: 206) were included. No statistically significant differences were demonstrated for postoperative complications (RR 0.91; 95% CI 0.67-1.23; I²=0%), reoperation (RR 0.90; 95% CI 0.38-2.15; I²=0%), mortality (RR 0.70; 95% CI 0.20-2.39; I²=0%), length of hospital stay (MD 0.25 days; 95% CI - 17.20 to 17.70; I²=94%), time to full enteral feeding (MD 0.21 days; 95% CI - 5.01 to 5.43; I²=62%), or time to first enteral feeding (MD - 4.79 days; 95% CI - 11.50 to 1.92; I²=93%). Confidence intervals were wide for all outcomes. TAP was performed in only 21-33% of patients across all cohorts, a pattern consistent with selective reservation for anatomically complex cases. CONCLUSION: No statistically significant postoperative advantage was identified for routine TAP over primary anastomosis. However, equivalence cannot be concluded given wide confidence intervals and substantial heterogeneity. Critically, the consistent minority utilization of TAP across centers, combined with directionally opposing individual-study findings, points to patient selection rather than operative technique as a likely dominant outcome driver. We propose, as a hypothesis for prospective evaluation rather than an evidence-based recommendation, that any benefit of tapering is most likely to be realized in anatomically complex cases with severe proximal dilation and marked caliber mismatch, rather than through universal application. Prospective multicenter studies with standardized atresia phenotyping and objective TAP-selection criteria are required. PROSPERO TRIAL REGISTRATION: CRD420261329962.