StayCurrentMD · Duodeno-duodenostomy for Duodenal Atresia
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Video7 min·Published Jun 2021Older

Duodeno-duodenostomy for Duodenal Atresia

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What the experts said0 expert statements · 22 host summaries
The patient is a two-day-old boy with duodenal atresia.
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A transverse right abdominal incision allows access to the duodenum and small intestine.
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Malrotation is present in this case.
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Duodenal atresia type III is present in this case.
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The proximal duodenal opening is made at the most dependent part.
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The distal limb is opened on the anterolateral surface to avoid injury to the opening of the common bile and pancreatic ducts.
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Bile coming out on opening of the distal limb confirms patency to that point.
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The diamond-shaped technique creates two openings with perpendicular axes.
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Distal patency is checked by injecting saline and observing its filling to the whole bowel.
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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.
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The posterior wall is sutured from the inside with full-thickness sutures.
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The anterior wall is sutured from the outside.
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5-0 absorbable sutures are used for the anastomosis.
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Suturing starts with the middle of the posterior wall and advances toward the angles with interrupted sutures.
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The angle suture is placed from the outside in an extramucosal fashion.
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The anterior wall sutures are placed in an extramucosal fashion starting from the angles and working towards the middle.
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The proximal dilated pouch is brought downwards to meet the distal limb during anterior wall closure.
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Widening of the root of the mesentery is performed after completing the anastomosis.
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The superior mesenteric vessels should be visualized during mesenteric root widening.
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The peritoneal covering is carefully dissected to allow adequate widening of the mesenteric root.
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Appendectomy is performed as part of the procedure.
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The bowel is returned to the abdomen with the colon in the left side and the duodenojejunal junction in a straight direction.
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