Technique: Laparoscopic Repair of Duodenal Atresia, Ladd's Procedure, and...

The patient is a 1 day old infant who had a prenatal diagnosis of duodenal atresia

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

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

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

The child is malrotated with a complete duodenal atresia

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

A Meckel's diverticulum is found in the distal ileum during the procedure

All of the small bowel is placed on the patient's right and the large bowel on the patient's left

Widening the mesenteric base should diminish the chance of volvulus in the future

A transverse enterotomy is made at the most dependent portion of the dilated proximal segment

The enterotomy in the distal segment is longitudinal

There is increased smoke and debris from using electrocautery compared to the 3 millimeter sealer

A transabdominal stitch aligns the two sides of the bowel to perform the side to side anastomosis

A pre-cut Vicryl suture approximately 10 to 12 centimeters in length is used to run the back row of the anastomosis

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

The surgeon prefers running suture over interrupted suture as it works extremely well and is more efficient

The entire procedure took approximately 50 minutes

Approximately 10% of patients undergoing laparoscopic repair of duodenal atresia have malrotation

The patient is a 2.8 kg child

A nasogastric tube is left to suction for approximately 3 to 4 days, and in most cases feeds are started by the 5th day

This child started eating on the 5th postoperative day and was on full feeds by the 8th postoperative day

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

The left quadrant 3 millimeter port was changed to a 5 millimeter port to allow insertion of the endoscopic stapler

Because of the malrotation, the appendix was also removed

The child was discharged to home on the 10th postoperative day