# Duodeno-duodenostomy for Duodenal Atresia — GCMD Library

In this video, duodeno-dudenostomy diamond anastomsis for duodenal atresia is demonstrated. The patient is a 2 day old boy that is presented with greenish vomiting since birth. Exploration revealed complete duodenal atresia type three and midgut malrotation. The video shows the surgeon's point of view (POV).

In this procedure, the operative steps are played in normal speed while some of the steps is played in faster speed for illustration purpose. The original video is one hour and 210. minutes.
Surgical steps a described in the subtitles during the video. This is an educational video designed for junior pediatric surgeons in training.

This video is intended as an education material and should not replace formal surgical training.

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For feedback, feel free to contact me: tamer_ashraf@yahoo.com
Tamer Ashraf Wafa PhD, MRCS
Assists Professor, Pediatric Surgery Department

Type: video · 7 min · posted 2021-06-11 Canonical: https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139 ## Chapters - [0:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=0) Introduction and Initial Exposure - [1:30](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=90) Mobilization and Exposure of Atresia - [3:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=180) Creation of Anastomotic Openings - [5:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=300) Duodeno-duodenostomy Anastomosis - [6:20](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=380) Malrotation Correction and Closure ## Statements - "Patient is a two-day-old boy with duodenal atresia" (clinical) [0:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=0) - "Transverse right abdominal incision allows access to duodenum and small intestine" (clinical) [0:20](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=20) - "Duodenal atresia type III is present" (clinical) [1:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=60) - "Malrotation is identified intraoperatively" (clinical) [1:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=60) - "Small and large intestine should be inspected for any other level atresia or rotational anomalies" (clinical) [0:50](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=50) - "The proximal opening should be made at the most dependent part" (clinical) [2:20](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=140) - "The distal limb should be opened on the anterolateral surface to avoid injury to the opening of the common bile and pancreatic ducts" (clinical) [2:45](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=165) - "Bile coming out on opening of the distal limb confirms communication with biliary system" (clinical) [3:05](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=185) - "The technique creates two diamond-shaped openings with perpendicular axes" (clinical) [3:15](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=195) - "Distal patency should be checked by injecting saline and observing its filling to the whole bowel" (clinical) [3:30](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=210) - "The anastomosis uses opposing borders of the diamonds for the posterior wall and far-facing borders for the anterior wall" (clinical) [3:50](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=230) - "Posterior wall suturing starts from the inside until angles are joined, then anterior wall is sutured from the outside" (clinical) [4:10](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=250) - "5-0 absorbable sutures are used for the anastomosis" (clinical) [4:40](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=280) - "Posterior wall sutures are full thickness interrupted sutures" (clinical) [4:35](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=275) - "Angle sutures are placed from the outside in an extramucosal fashion" (clinical) [5:00](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=300) - "Anterior wall sutures are placed in an extramucosal fashion starting from the angles and working towards the middle" (clinical) [5:40](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=340) - "The proximal dilated pouch is brought downwards to meet the distal limb during anterior wall closure" (clinical) [5:55](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=355) - "Widening of the root of the mesentery is performed to address malrotation" (clinical) [6:20](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=380) - "Superior mesenteric vessels should be visualized during mesenteric root widening" (clinical) [6:25](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=385) - "Peritoneal covering is carefully dissected to allow adequate widening of mesenteric root" (clinical) [6:30](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=390) - "Appendectomy is performed as part of the procedure" (clinical) [6:40](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=400) - "Final bowel positioning places colon in the left side and duodenojejunal junction in a straight direction" (clinical) [6:48](https://library.globalcastmd.com/watch/duodeno-duodenostomy-for-duodenal-atresia-4139?t=408) ## Transcript Hello and welcome. This video shows a duodenal duodenostomy for duodenal atresia in a two-day-old boy. A transverse right abdominal incision is made to allow access to the duodenum and small intestine as well. On entering the abdomen, the dilated stomach and proximal duodenum are seen. The small and large intestine are exteriorized and inspected for any other level atresia or rotational anomalies. Here, a medgottma rotation is noticed and duodenal atresia type III is present. The root of the mesentery is exposed to evaluate the width of the duodenocolic isthmus. The end of the mesentery is the end of the mesentery. The end of the mesentery is the end of the mesentery. Now, the duodenum and the duodenodiginal junction is freed from their attachment to the posterior abdominal wall. Then, the lateral attachment of the proximal duodenum is dissected to expose the upper atritic pouch. The proximal and distal parts are clearly in view with the pancreas in between. The proximal and distal and distal and distal and distal and distal vertical direction. The proximal opening is made with the proximal opening at the most dependent part. Stay sutures are placed to the sides and angles of the openings. The distal and distal limb is opened on the anterolateral surface to avoid injury to the opening of the common bile and pancreatic ducts. Note that bile is coming out on opening of the distal limb. This creates two diamond-shaped openings with perpendicular axes. After opening the lumen, the distal patency is checked by injecting saline and observing its filling to the whole bowel. Now, the plan is to make an anastomosis with the two opposing borders of the diamonds to make the posterior wall of the anastomosis while the far-facing borders to make the anterior wall. The anastomosis will start by suturing the posterior wall from the inside till the angles are joined. Then, the anterior wall is sutured from the outside. Suturing is started with the middle of the posterior wall with full thickness sutures using 5-O absorbable sutures. Suturing is advanced on the medial half with interrupted sutures. Suturing is advanced on the outside. The angle suture is placed from the outside in an extramucosa fashion. Now, half of the posterior wall sutures are placed and the other half sutures are now placed in the same way. of the two o'rgay. Thank you. Now the posterior wall is completed. The anterior wall sutures are placed in an extra-mukula fashion starting from the angles and working towards the middle. At this point, the proximal dilated pouch is brought downwards to meet the distal limb. Now the Anastomosis is successfully completed. Attention is now directed towards widening of the root of the mesentery. The superior mesenteric vessels should be visualized and the peritoneal covering is carefully dissected to allow adequate widening. The procedure is concluded by appendectomy. The bowel is returned to the abdomen with the colon in the left side and the DJ in a straight direction. Thank you for watching. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai