Laparoscopic treatment of a duodenal atresia in a newborn

Duodenal atresia is one of the more common intestinal anomalies treated by pediatric surgeons, occurring 1 in 2,500-5,000 live births. The treatment is surgical and consists of duodeno-duodenostomy in the newborn period. This video shows the laparoscopic treatment of this congenital anomaly.

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Laparoscopic treatment of a duodenal atresia in a newborn

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Abstract

Duodenal atresia is one of the more common intestinal anomalies treated by pediatric surgeons, occurring 1 in 2,500-5,000 live births. The treatment is surgical and consists of duodeno-duodenostomy in the newborn period. This video shows the laparoscopic treatment of this congenital anomaly.

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contribution

Keywords

Laparoscopic treatment, duodenal atresia, newborn

Media type

Surgical video

Duration

04'33''

Publication

2010-05

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E-publication

WeBSurg.com, May 2010;10(05).
URL: http://www.websurg.com/doi-vd01en2953.htm

Laparoscopic treatment of a duodenal atresia in a newborn

1. Operative settings 00'07''

The child is intubated and ventilated, and is operated upon under general anesthesia. Intra-abdominal insufflation pressures are low, around 5mmHg with a rate of 1.5 L/min. The child is placed in supine position at the edge of the operating table. The monitor is located in front of the operator, at the level of the patient’s head. The scrub nurse is at the operator’s right and the assistant is at the surgeon’s left. A 5mm trocar is placed laterally and supra-umbilically to avoid the urachus still patent at this age and the umbilical vein still patent too. Two 3mm lateral trocars are introduced under the level of the umbilicus so that they are as far as possible from the operating site.

2. Duodenal dilatation 00'46''

The anomaly is seen here with a dilated duodenal pouch above the atresia, and immediately underneath aberrant pancreatic tissue and the small non-functioning caudal duodenum. The procedure will consist in making a duodeno-duodenal anastomosis.

3. Atresia identification 01'01''

After identification of the two atresial extremities, we will suspend the round ligament to retract the liver with a transparietal thread tied to a pledget out of the abdomen. The atresia’s superior extremity is easily found. The atresia’s distal extremity must be unrolled as it is posterior and below the pancreas. In this case, we observe a mesenteric malrotation: the duodenojejunum unrolls to the right of the abdominal cavity.

4. Pylorus suspension 02'03''

Following perfect identification of the two duodenal portions that need to be anastomosed, we will suspend the pylorus transparietally with a stitch that will be tied to a pledget out of the abdominal cavity. The pledget allows to avoid suture marks on the anterior abdominal cavity.

5. Duodenal opening 02'21''

In this way, the anastomotic region will be stabilized and the superior duodenal pouch, dilated, situated immediately above the pancreatic tissue that can be seen here, will be opened vertically using a monopolar hook. Both duodenal pouches are freed by performing a kocherization. This allows a good mobilization of the superior and inferior duodenal pouches, above and below the atresia. After opening the superior pouch, we will join it with the inferior pouch before its opening. The anastomosis is diamond-shaped as can be seen on this picture.

6. Anastomosis 03'36''

The first anastomotic stitches will be passed using Vicryl 6/0. The suture is made of interrupted stitches, tied intra-abdominally. A few stitches are sufficient to join the anastomotic margins. A final check of the anastomosis shows that there is still an area that may be fistulous, and requires an extra stitch. The anastomosis is performed. A nasogastric probe is left in place. The pylorus is freed from its suspension stitch. The procedure is now finished. No trans-anastomotic probe is placed. From the third postoperative day onwards, the patient is gradually fed.