The role of laparoscopy in the treatment of duodenal obstruction in term and preterm infants

Abstract

Purpose: The aim of this study was to evaluate the role of laparoscopy in the surgical treatment of intrinsic and extrinsic duodenal lesions referring to the underlying cause of obstruction.

Methods: Retrospective chart review of all cases of duodenal obstructions undergoing surgery at our institution between April 2004 and March 2012.

Results: Twenty patients underwent surgery for duodenal obstruction (11 female, 9 male). Seven infants were born prematurely. Eleven infants had extrinsic, seven had intrinsic and two had a combination of intrinsic and extrinsic duodenal lesions. A laparoscopic procedure was initially started in 18 of 20 patients (90 %). Thirteen of the 18 infants (72 %) underwent various laparoscopic procedures: laparoscopic duodenoduodenostomy, resection of a duodenal membrane and the transsection of Ladd's bands. In five patents, a conversion became necessary due to poor visualisation of the duodenum. In three patients (15 %) with extrinsic duodenal lesion a reoperation was necessary. Two of the 20 patients (10 %) were operated with an "open" approach to begin with.

Conclusion: Laparoscopy is feasible and safe in most cases. The few conversions were early in the series due to a lack of experience and necessitated by poor visualisation, most often caused by malrotation.