# Duodenal Atresia — GCMD Library living collection

Everything in the library about duodenal atresia — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 46 cited statements

## Episodes
### Surgical Management
- [Technique: Laparoscopic Repair of Duodenal Atresia, Ladd's Procedure, and...](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761) — video · 15:01 · [machine version](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761.md)
- [Duodeno-duodenostomy for Duodenal Atresia](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139) — video · 7:04 · [machine version](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139.md)

### Evidence & Research
- [BOB in Ped Surg 2023 - CIPESUR Winner - Georgina Falcioni, MD](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320) — video · [machine version](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=0) Room Setup, Port Placement, and Initial Dissection (Ep 1)
- [3:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=180) Ladd's Procedure and Identification of Malrotation (Ep 1)
- [6:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=360) Duodenoduodenostomy (Ep 1)
- [12:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=720) Resection of Meckel's Diverticulum and Appendix (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=0) Exposure and Initial Findings (Ep 2)
- [1:30](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=90) Duodenal Mobilization and Opening (Ep 2)
- [3:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=180) Anastomosis Construction (Ep 2)
- [5:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=300) Mesenteric Widening and Closure (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=0) Introduction of CIPESUR presentations and audience voting (Ep 3)
- [1:51](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=111) Telesimulation study presentation: methods and results (Ep 3)
- [5:06](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=306) Discussion of telesimulation scope and limitations (Ep 3)
- [8:09](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=489) Panel reactions and advantages of remote teaching (Ep 3)
- [9:53](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=593) Author closing remarks on practical implementation (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The patient is a two-day-old boy with duodenal atresia." (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=0)
- "A transverse right abdominal incision allows access to the duodenum and small intestine." (host_summary) [Ep 2 · 0:20](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=20)
- "Malrotation is present in this case." (host_summary) [Ep 2 · 1:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=60)
- "Duodenal atresia type III is present in this case." (host_summary) [Ep 2 · 1:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=60)
- "The proximal duodenal opening is made at the most dependent part." (host_summary) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=120)
- "The distal limb is opened on the anterolateral surface to avoid injury to the opening of the common bile and pancreatic ducts." (host_summary) [Ep 2 · 2:30](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=150)
- "Bile coming out on opening of the distal limb confirms patency to that point." (host_summary) [Ep 2 · 2:45](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=165)
- "The diamond-shaped technique creates two openings with perpendicular axes." (host_summary) [Ep 2 · 2:55](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=175)
- "Distal patency is checked by injecting saline and observing its filling to the whole bowel." (host_summary) [Ep 2 · 3:10](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=190)
- "The anastomosis technique uses two opposing borders of the diamonds to make the posterior wall and the far-facing borders to make the anterior wall." (host_summary) [Ep 2 · 3:25](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=205)
- "The posterior wall is sutured from the inside with full-thickness sutures." (host_summary) [Ep 2 · 3:50](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=230)
- "The anterior wall is sutured from the outside." (host_summary) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=240)
- "5-0 absorbable sutures are used for the anastomosis." (host_summary) [Ep 2 · 4:10](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=250)
- "Suturing starts with the middle of the posterior wall and advances toward the angles with interrupted sutures." (host_summary) [Ep 2 · 4:10](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=250)
- "The angle suture is placed from the outside in an extramucosal fashion." (host_summary) [Ep 2 · 4:35](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=275)
- "The anterior wall sutures are placed in an extramucosal fashion starting from the angles and working towards the middle." (host_summary) [Ep 2 · 5:10](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=310)
- "The proximal dilated pouch is brought downwards to meet the distal limb during anterior wall closure." (host_summary) [Ep 2 · 5:30](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=330)
- "Widening of the root of the mesentery is performed after completing the anastomosis." (host_summary) [Ep 2 · 5:50](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=350)
- "The superior mesenteric vessels should be visualized during mesenteric root widening." (host_summary) [Ep 2 · 6:05](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=365)
- "The peritoneal covering is carefully dissected to allow adequate widening of the mesenteric root." (host_summary) [Ep 2 · 6:15](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=375)
- "Appendectomy is performed as part of the procedure." (host_summary) [Ep 2 · 6:30](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=390)
- "The bowel is returned to the abdomen with the colon in the left side and the duodenojejunal junction in a straight direction." (host_summary) [Ep 2 · 6:40](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=400)
- "The patient is a 1 day old infant who had a prenatal diagnosis of duodenal atresia" (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=0)
- "Port placements consist of a 4 millimeter scope in the umbilicus, a 3 millimeter port in the left mid quadrant, and a 3 millimeter stab wound in the right mid quadrant, triangulated towards the right upper quadrant" (clinical) [Ep 1 · 0:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=30)
- "The 3 millimeter sealer is an excellent dissecting device and can be used in safe energy in close approximation to both the gallbladder and the small bowel" (opinion) [Ep 1 · 1:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=60)
- "A transabdominal stitch using a 30 Prolene on an RB1 needle is placed through the anterior abdominal wall in the right upper quadrant to retract the gallbladder superiorly" (clinical) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=120)
- "The child is malrotated with a complete duodenal atresia" (clinical) [Ep 1 · 2:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=150)
- "The bowel is run from proximal to distally to ensure that there are no further Ladd's bands and to completely de-rotate the bowel" (clinical) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=180)
- "A Meckel's diverticulum is found in the distal ileum during the procedure" (clinical) [Ep 1 · 3:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=210)
- "All of the small bowel is placed on the patient's right and the large bowel on the patient's left" (clinical) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=240)
- "Widening the mesenteric base should diminish the chance of volvulus in the future" (clinical) [Ep 1 · 4:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=270)
- "A transverse enterotomy is made at the most dependent portion of the dilated proximal segment" (clinical) [Ep 1 · 5:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=300)
- "The enterotomy in the distal segment is longitudinal" (clinical) [Ep 1 · 5:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=330)
- "There is increased smoke and debris from using electrocautery compared to the 3 millimeter sealer" (clinical) [Ep 1 · 6:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=360)
- "A transabdominal stitch aligns the two sides of the bowel to perform the side to side anastomosis" (clinical) [Ep 1 · 6:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=390)
- "A pre-cut Vicryl suture approximately 10 to 12 centimeters in length is used to run the back row of the anastomosis" (clinical) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=420)
- "In some cases, the distal duodenal segment is more fixed to the retroperitoneum, making this part of the procedure more difficult, but the same technique is used with excellent result" (clinical) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=480)
- "The surgeon prefers running suture over interrupted suture as it works extremely well and is more efficient" (opinion) [Ep 1 · 9:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=540)
- "The entire procedure took approximately 50 minutes" (clinical) [Ep 1 · 9:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=570)
- "Approximately 10% of patients undergoing laparoscopic repair of duodenal atresia have malrotation" (epidemiological) [Ep 1 · 10:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=600)
- "A nasogastric tube is left to suction for approximately 3 to 4 days, and in most cases feeds are started by the 5th day" (clinical) [Ep 1 · 10:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=630)
- "This child started eating on the 5th postoperative day and was on full feeds by the 8th postoperative day" (clinical) [Ep 1 · 11:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=660)
- "The base of the Meckel's diverticulum could adequately be divided without compromising the lumen of the bowel, so a decision was made to remove it using the 5 millimeter stapler" (clinical) [Ep 1 · 12:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=720)
- "The left quadrant 3 millimeter port was changed to a 5 millimeter port to allow insertion of the endoscopic stapler" (clinical) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=780)
- "Because of the malrotation, the appendix was also removed" (clinical) [Ep 1 · 13:30](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=810)
- "The child was discharged to home on the 10th postoperative day" (clinical) [Ep 1 · 14:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=840)
- "The patient is a 2.8 kg child" (clinical) [Ep 1 · 10:00](https://library.globalcastmd.com/watch/technique-laparoscopic-repair-of-duodenal-atresia-ladd-s-procedure-and-761?t=600)
- "In-person proctor-trainee simulation-based education has been the standard choice for MIS skills training programs development at Garrahan Children's Hospital since 2012." — Georgina Falcioni (clinical) [Ep 3 · 1:51](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=111)
- "During the Covid-19 pandemic, the curricula was adapted to a telesimulation essential skills training model, which was reported at IPAC 2021." — Georgina Falcioni (clinical) [Ep 3 · 2:20](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=140)
- "Both standard and telesimulation essential skills training models included academic lectures, tutorials for ergonomics, and seven performance tasks, with hands-on practice scheduled into two sessions of three hours." — Georgina Falcioni (clinical) [Ep 3 · 2:40](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=160)
- "The study randomly selected 20 participant assessments from different institutions for each group (telesimulation and standard simulation)." — Georgina Falcioni (clinical) [Ep 3 · 3:05](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=185)
- "The telesimulation group accessed all content through an online campus and completed hands-on practice with a proctor through a virtual meeting platform." — Georgina Falcioni (clinical) [Ep 3 · 3:20](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=200)
- "The standard simulation group attended conferences and hands-on practice at the simulation center with an onsite proctor." — Georgina Falcioni (clinical) [Ep 3 · 3:35](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=215)
- "Both groups had the same educators giving summative feedback and debriefing." — Georgina Falcioni (clinical) [Ep 3 · 3:45](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=225)
- "The three assessed tasks were circle cutting pattern, extracorporeal reder knot, and intracorporeal square knot." — Georgina Falcioni (clinical) [Ep 3 · 3:55](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=235)
- "For precision circle cutting, there was significant improvement in score and significant decrease in time between initial and final assessments independently for both telesimulation and standard simulation groups." — Georgina Falcioni (clinical) [Ep 3 · 4:10](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=250)
- "When comparing the achieved progress between both groups for circle cutting, there were no statistically significant differences between telesimulation and standard simulation groups." — Georgina Falcioni (clinical) [Ep 3 · 4:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=270)
- "For the extracorporeal knot task, a similar pattern was observed showing considerable and almost parallel progress in initial and final assessments for both telesimulation and standard simulation groups." — Georgina Falcioni (clinical) [Ep 3 · 4:45](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=285)
- "For the intracorporeal square knot task, results showed improvement in score and decrease in time, with comparative outcomes relatively symmetric for telesimulation and standard simulation groups after practice." — Georgina Falcioni (clinical) [Ep 3 · 5:00](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=300)
- "Statistically significant improvements in scores and decrease in times were observed for all assessed tasks in both telesimulation and standard simulation groups." — Georgina Falcioni (clinical) [Ep 3 · 5:20](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=320)
- "The comparative progression observed in telesimulation and standard simulation groups were effective and accounted almost parallel." — Georgina Falcioni (clinical) [Ep 3 · 5:40](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=340)
- "Data analysis shows that close performance could be achieved with both telesimulation and standard simulation strategies." — Georgina Falcioni (clinical) [Ep 3 · 5:55](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=355)
- "Telesimulation can provide educational benefit in MIS essential skills training to learners who don't have direct access to onsite simulation resources within a proctor training program." — Georgina Falcioni (opinion) [Ep 3 · 6:10](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=370)
- "Telesimulation allows learners to learn from expert mentors who may not live in their city or country." — Todd Ponsky (opinion) [Ep 3 · 6:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=390)
- "High-fidelity simulation is more complicated to do via telesimulation because it sometimes requires equipment like pumps to make lungs breathe that cannot easily be sent to trainees' homes." — Cecilia (host_summary) [Ep 3 · 6:50](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=410)
- "Low-fidelity simulation involves practicing skills of movement such as moving a peg from one place to another, cutting, and sewing." — Todd Ponsky (host_summary) [Ep 3 · 7:20](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=440)
- "High-fidelity simulation involves replicas of actual tissue where surgeons try to simulate procedures like esophageal atresia or duodenal atresia repair." — Todd Ponsky (host_summary) [Ep 3 · 7:45](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=465)
- "High-fidelity telesimulation is possible but not quite developed yet, with multiple places developing new approaches." — Cecilia (host_summary) [Ep 3 · 8:05](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=485)
- "Virtual reality and artificial intelligence may help address missing elements like haptics in telesimulation." — Cecilia (host_summary) [Ep 3 · 8:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=510)
- "Telesimulation allows trainees to take models home and practice during their free time outside of work or fellowship." — Cecilia (host_summary) [Ep 3 · 9:25](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=565)
- "Telesimulation is very low cost because it uses trainers that can be sent like toys and doesn't need fancy equipment, using only tablets or phones." — Marcela (clinical) [Ep 3 · 10:20](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=620)
- "The most difficult part of telesimulation is finding good educators and establishing effective communication." — Marcela (opinion) [Ep 3 · 10:45](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=645)
- "Doing very good intracorporeal suturing in a very small space (low-fidelity skill) will translate to high-fidelity models of newborn procedures." — Marcela (opinion) [Ep 3 · 11:00](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=660)
- "Essential low-fidelity skills training should be completed before arranging an advanced course." — Marcela (opinion) [Ep 3 · 11:20](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-cipesur-winner-georgina-falcioni-md-6320?t=680)

## Changelog
- Sep 25: 3 items added automatically

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