Laparoscopic repair of duodenal atresia: revisited

Abstract

Background: Since the initial reports of laparoscopic repair of duodenal atresia in neonates, further reports have been scant. Could this be because of unacceptable rates of complications, like anastomotic leakage, as mentioned in later reports? In the present study the laparoscopic repair of duodenal atresia in neonates is revisited.

Patients: Group 1 consisted of 22 patients with duodenal obstruction between 2000-2005 until the laparoscopic approach was abandoned. Of these 22 patients, 10 had Down syndrome and 8 had concomitant malformations. In this group 18 patients were operated laparoscopically. Four patients underwent an open procedure. Group 2 consisted of six patients that underwent operation between 2008 and February 2010.

Results: In group 1 there were four conversions. In 14 patients the procedure could be completed laparoscopically. In five patients postoperative leakage occurred. The complication rate was found to be unacceptably high, and the laparoscopic approach was abandoned. After gaining additional experience in intracorporeal suturing and adjusting the technique, the procedure was started up again in 2008. Since then six consecutive neonates have undergone laparoscopic repair of duodenal atresia without complications.

Conclusions: Laparoscopic repair of duodenal atresia is one of the most demanding pediatric laparoscopic surgical procedures. After initial promising results at the beginning of the twenty-first century a relative "radio silence" followed, apparently caused by unsatisfactory results. Only considerable adjustments in technique and extensive improvement in experience has led to acceptable outcomes more recently. Laparoscopic repair of duodenal atresia should therefore be restricted to pediatric centers with extensive experience in laparoscopic surgery and intracorporeal suturing.

Fig. 1

A Stay sutures (s) in bulbus duodeni. B First suture (a) from lateral border of incision in bulbus duodeni (x) to halfway lateral border of distal duodenum (x’). The suture is led out through the abdominal wall. C Second suture (b) from medial border of bulbus duodeni (y) to half way medial side of distal duodenum (y′). D After bringing the suture (b) to the inside of the duodenum a running suture runs from y to x, where the suture is brought outside again and tied with a