Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs

Background  All hernia recurrences in a series of 505 patients who underwent laparoscopic repair of a ventral hernia (n = 291) or incisional hernia (n = 214) were analyzed to identify factors responsible for the recurrence. Methods  In all laparoscopic repairs, an expanded polytetrafluoroethylene prosthesis overlapping the hernia margins by ≥3 cm was fixed with a double ring of tacks alone (n = 206) or with tacks as well as sutures (n = 299). During the mean follow-up time of 31.3 ± 18.4 months, nine patients (1.8%) had a recurrence, eight of which were repaired laparoscopically. Operative reports and videotapes of all initial repairs and repairs of recurrences were analyzed. Results  All recurrences followed an incisional hernia repair (p < 0.001). Five recurrences developed after mesh fixation with both tacks and sutures and four after mesh fixation with tacks alone (p = 1.0). All recurrences were at the site of the apparently sufficient original incision scar: in eight patients, the recurrent hernia was attached to the mesh; in one, it developed in another part of the scar. All initial repairs had been performed without technical errors. Upon repair of the recurrences, a new, larger mesh was placed over the entire incision, not just the hernia. There were no re-recurrences during follow-up (mean 19.8 ± 10.3 months). Conclusions  Recurrence after incisional hernia repair appears to be due primarily to disregard for the principle that the whole incision—not just the hernia—must be repaired. Our experience supports the idea that the entire incision has a potential for hernia development. Insufficient coverage of the incision scar is a risk factor for recurrence after laparoscopic repair of ventral and incisional hernia.     

Endoscopic therapy of the buried bumper syndrome: a clinical algorithm

Background Buried bumper syndrome is a rare complication of percutaneous endoscopic gastrostomy with an overgrowth of the inner flange of the tube. Various therapeutic approaches in case studies in the literature are described. Methods We present the prospective data collection and analysis of 18 cases of buried bumper syndrome treated in our institution between 1 January 1998 and 31 December 2005. Results The median length of time after the first percutaneous endoscopic gastrostomy (PEG) tube insertion was 35 months (range = 1–168 months). In 37 endoscopic interventions all ingrown PEG’s could be removed or replaced. Our experience resulted in a structured clinical treatment algorithm. Conclusion In all cases inadequate gastrostomy care must be assumed as the reason for bumper overgrowth. Following ESPEN guidelines for PEG care may prevent BBS. BBS can routinely be diagnosed and treated by upper gastrointestinal endoscopy in a minimally invasive manner.     

Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma

Background  Lymph node dissection and esophageal anastomosis, considered the more demanding steps of laparoscopic gastrectomy for gastric adenocarcinoma, can be performed with the use of a remote-controlled robot. Methods  Thirteen patients with a histologically proved gastric cancer (six stage I, six stage II, and one stage III) were enrolled in a prospective study to assess feasibility and safety of the Da Vinci surgical system in total and partial gastrectomy with extended lymph node dissection. Outcome measures were conversion rate, intra- and postoperative morbidity and mortality, operative time, blood loss, number of lymph nodes harvested, and macroscopic and microscopic evaluation of resection margins. Results  Eight distal, four total, and one proximal laparoscopic gastrectomies were completed without conversion. Extended lymph node dissection, and esophagojejunal and esophagogastric anastomoses were successfully carried out using the da Vinci System. Mean operative time was 286 ± 32.6 min and blood loss was 103 ± 87.5 ml. Mean number of nodes retrieved was 28.1 ± 8.3 and all resection margins were negative. There was no mortality. Trocar bleeding requiring laparoscopy was the only major complication encountered. No recurrence occurred during a mean follow-up time of 12.2 ± 4.5 months. Conclusions  Robot-assisted laparoscopic lymph node dissection and esophageal anastomosis are feasible and safe. Longer follow-up time and randomized studies are needed to evaluate long-term outcome and clinical advantages of this new technology.     

Laparoscopic Resection of a Pheochromocytoma at the Organ of Zuckerkandl in a 13-year old child

Presented is a case of a 13 year old boy who was seen by his pediatrician with complaints of profuse sweating and intermittent headaches. A routine blood pressure measurement at that time was markedly elevated at 180/110 mmHg. A 24-hour urinary catecholamine evaluation was positive for the presence of metanephrines. Serum samples confirmed the presence of high levels of circulating catecholamines, suggesting the diagnosis of a pheochromocytoma. An MRI of the abdomen was obtained which demonstrated the presence of a 5 cm mass between the iliac arteries behind the rectum. An (123)I-metaiodobenzylguanidine (MIBG) scan revealed an enhancing lesion at the Organ of Zuckerkandl with no other lesions present. The diagnosis of an extra adrenal pheochromocytoma was established. After appropriate pharmacologic adrenergic blockade, the patient was brought to the operating room for a laparoscopic resection. The accompanying video illustrates a laparoscopic resection of a pheochromocytoma at the Organ of Zuckerkandl using a 10-mm port for the umbilicus and 3 5-mm working ports. The working ports were placed in the left upper quadrant, right upper quadrant, and right lower quadrant. The mass was removed using an Endocatch bag through an extension of the umbilical incision. The patient tolerated the procedure quite well, and the patient was started on a clear liquid diet on post-operative day number one. The patient was discharged home on post-operative day number three, tolerating a regular diet, and and oral pain medicine. The patient is currently symptom free with normal catecholamine levels 12 months after surgery. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Medial-to-lateral laparoscopic colon resection: a view beyond the learning curve

Background Since the authors’ report on the lateral approach to laparoscopic colon resection (LCR), medial-to-lateral (M-L) segmental resection has continued to evolve. This report analyzes their learning curve experience with a standardized three-trocar M-L technique, which demonstrates the influence of operative volume on proficiency and outcome. Methods From January 1999 to December 2004, 100 consecutive patients underwent a standardized three-trocar M-L segmental LCR. Patient demographics, indications for surgery, operative proficiency (time), and outcome (i.e., blood loss, conversion to open surgery, length of hospital stay, morbidity, and mortality) were recorded. A learning curve analysis was performed using a t-test and analysis of variance (ANOVA). Results The 100 M-L LCRs included sigmoid (55%), right (34%), left (6%), and transverse (5%) approaches. Overall learning curve proficiency was influenced by increasing operative experience (p = 0.02). However, significant and consistent improvement in the learning curve occurred only after 38 LCRs (p < 0.008). Notably, all conversions to open surgery (3%) occurred during the early learning curve. Similarly, early LCR patients experienced greater morbidity (mean, 21% vs 12%) and mortality (mean, 5% vs 2%) than their later counterparts. Conclusion To obtain optimum proficiency in performing LCR, a minimum of 38 M-L procedures is required. Operative and patient outcomes improve beyond the early learning curve.     

Roux-en-Y duodenojejunostomy for surgical management of isolated duodenal obstruction due to chronic pancreatitis

IntroductionDuodenal obstruction in case of chronic pancreatitis is a very rare occurrence and usually presents with gastric outlet obstruction. These cases sometimes require surgical intervention when conservative treatment fails. Gastrojejunostomy and vagotomy has conventionally been performed for management of these cases.Presentation of caseIn this report, we present two cases of isolated duodenal obstruction due to chronic pancreatitis that were managed with Roux-en-Y duodenojejunostomy. All the patients had uneventful post-operative recovery and remained symptom free up to two years of follow up.DiscussionThe isolated duodenal obstruction in chronic pancreatitis is very rare occurring due to fibrotic scarring following pancreatic inflammation an irreversible phenomenon requiring drainage procedure. The advantage of performing Roux-en-Y duodenojejunostomy in these cases is that it avoids complications of gastrojejunostomy such as bile reflux and stomal ulcerations.ConclusionRoux-en-Y duodenojejunostomy should be considered as an alternative procedure when duodenal obstruction occurs beyond second part of duodenum.     

Prone thoracoscopic esophageal mobilization for minimally invasive esophagectomy

Background Minimally invasive esophagectomy is a complex surgical procedure. We recently began performing thoracic mobilization of the esophagus with the patient in the prone position, not the left lateral decubitus position, in the hope of minimizing the number of technical challenges. Methods Six consecutive minimally invasive esophagectomies were performed using prone thoracoscopic esophageal mobilization with creation of cervical anastamosis. Our esophagectomy database was evaluated for outcomes, including operative time, estimated blood loss, complications, and length of hospital stay. Results We were successful in our first six attempts, with a mean blood loss of 61 cc. Mean operative time for thoracoscopy was 80 min. Operative times were steady over the first six prone cases at 105, 85, 70, 55, 80, and 85 min. Three of the six patients had no complications. Median postoperative length of hospital stay was 11.5 days, and there were no deaths. Conclusions This technical report and case series demonstrates that prone thoracoscopic esophageal mobilization appears to be a reasonable alternative to the same procedure performed with the patient in the decubitus position. We find the technique to simplify portions of an otherwise difficult surgical procedure. Further evaluation with larger number of patients should be performed.     

Endoscopic repair of a large colonoscopic perforation with clips

We report a patient with a large colonic perforation that occurred in a screening colonoscopy, successfully repaired with endoclips, although the safety and efficacy of this approach is not entirely established. Endoscopic clip placement can be used to treat iatrogenic colonic perforation, when the defect is readily recognized and is easily accessible for closure, and the bowel preparation is excellent. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Single-incision laparoscopic cholecystectomy: surgery without a visible scar

Laparoscopic cholecystectomy has been recognized since 1992 as the gold standard procedure for gallbladder surgery. The authors propose a single-incision laparoscopic (SILS) cholecystectomy as a step toward less invasive surgical procedures. A single intraumbilical 12-mm incision is made, and the umbilicus is pulled out, exposing the fascia. Pneumoperitoneum is induced with the Versastep Veress access needle. A 5-mm trocar then is introduced, and the abdominal cavity is explored with a 5-mm 30° optic. Second and third trocars are introduced respectively at the left and right sides, near the first trocar. Two sutures are used to suspend the gallblabber and to ensure optimal exposure of the Triangle of Calot. Dissection is performed as a normal retrograde cholecystectomy using an Endoshear roticulator in the left trocar and an Endograsp roticulator in the right hand. The cystic artery and cystic duct are clipped separately with a standard 5-mm clip applier and then excised. The gallbladder is removed through the umbilical incision. Of the 12 patients who underwent SILS cholecystectomy without major complications, 8 had previously undergone other laparoscopic surgeries. The body mass index (BMI) exceeded 35 in three cases. Operative time decreased and stabilized from the first 3-h SILS cholecystectomy to approximately 50 min after the first five cases. At this writing, the authors find SILS cholecystectomy to be feasible, safe, and effective.     

Laparoscopic intrahepatic Glissonian approach for right hepatectomy is safe,simple, and reproducible

Background Hemorrhage from portal and hepatic veins is a major concern with laparoscopic right hepatectomy (LRH). The standard hilar approach is dissection of the portal pedicle outside the liver parenchyma with separate transection of the right hepatic artery, portal vein, and bile duct [1–5, 7, 9]. Variations in anatomy can hamper vascular and biliary control. The intrahepatic Glissonian access avoids these risks by en masse ligation of the portal structures without dissection for each separately [6, 8]. This technique was performed laparoscopically for the last 2 among 10 LRHs, and the results are presented. Methods Total LRH was performed under ultrasound assistance for two patients with malignancy. After lymph node sampling at the hepatoduodenal ligament, dissection was started with the incision of liver parenchyma posterior and anterior to the hilum, then continued outside the portal pedicle bifurcation toward the right and left sheaths. An endoscopic vascular stapling device was placed to transect the right portal pedicle en masse under direct laparoscopic vision and cholangiography guidance. Parenchymal transection and vascular control of the right hepatic vein was accomplished with harmonic scalpel, cavitron ultrasonic aspirator, bipolar diathermy, clips, and endoscopic stapling device, as appropriate. No Pringle’s maneuver was used. The specimen was extracted through a suprapubic incision using an endobag. Results The operative times for the two patients were, respectively, 180 and 240 min. No blood loss occurred during the intrahepatic Glissonian dissection. Intraoperative blood loss (from the right hepatic vein) of 700 and 800 ml, respectively, was controlled laparoscopically. The postoperative periods were uneventful, with discharge, respectively, on days 6 and 7. The surgical resection margins were free of tumor. Conclusions The laparoscopic intrahepatic Glissonian approach used for right hepatectomy is safe, simple, and reproducible. It facilitates the hepatic hilar dissection with minimal operative risk. Further implementation of this technique is encouraged to improve the outcome for patients undergoing laparoscopic liver resection. Electronic supplementary material The online version of this article (doi: ) contains supplementary material, which is available to authorized users     

Comparison of conventional laparoscopic and hand-assisted oncologic segmental colonic resection

Background Laparoscopically assisted colon resection has evolved to be a viable option for the treatment of colorectal cancer. This study evaluates the efficacy of hand-assisted laparascopic surgery (HALS) as compared with totally laparoscopic surgery (LAP) for segmental oncologic colon resection with regard to lymph node harvest, operative times, intraoperative blood loss, pedicle length, incision length, and length of hospital stay in an attempt to help delineate the role of each in the treatment of colorectal cancer. Methods Patient charts were retrospectively reviewed to acquire data for this evaluation. Between June 2001 and July 2005, 40 patients underwent elective oncologic segmental colon resection (22 HALS and 18 LAP). The main outcome measures included lymph node harvest, operative times, intraoperative blood loss, pedicle length, incision length, and length of hospital stay. Results The two groups were comparable in terms of demographics. The tumor margins were clear in all the patients. The HALS resection resulted in a significantly higher lymph node yield than the LAP resection (HALS: 16 nodes; range, 5–35 nodes vs LAP: 8 nodes; range, 5–22 nodes; p < 0.05) and significantly shorter operative times (HALS: 120 min; range, 78–181 min vs LAP: 156 min; range, 74–300 min; p < 0.05). Both groups were comparable with regard to length of hospital stay, pedicle length, and intraoperative blood loss. However, the LAP group yielded a significantly smaller incision for specimen extraction (LAP: 7 cm; range, 6–8 cm vs HALS: 5.5 cm; range, 5–7 cm; p < 0.05). Conclusion The findings suggest that hand-assisted laparoscopic oncologic segmental colonic resection is associated with shorter operative times, more lymph nodes harvested, and equivalent hospital stays, pedicle lengths, and intraoperative blood losses as compared with the totally laparoscopic approach. The totally laparoscopic technique was completed with a smaller incision. However, this less than 1 cm reduction in incision length has doubtful clinical significance.     

Medical effectiveness and safety of conventional compared to laparoscopic incisional hernia repair: A systematic review

Background Incisional hernias are a common complication following abdominal surgery and represent about 80% of all ventral hernia. In uncomplicated postoperative follow-up they develop in about 11% of cases and in up to 23% of cases with wound infections or other forms of wound complications. While conventional mesh repair has been the standard of care in the past, the use of laparoscopic surgery is increasing. It therefore remains uncertain which technique should be recommended as the standard of care. Objectives To compare the medical effectiveness and safety of conventional mesh and laparoscopic incisional hernia repair. Methods A structured literature search of databases accessed through the German Institute of Medical Documentation and Information (DIMDI) was conducted. English and German literature published until August 2005 was included and their methodological quality assessed. Results The search identified 17 relevant publications and included 15 studies for final assessment. Among those were one meta-analysis, one randomized clinical trial (RCT) ,and 13 cohort studies. All studies suffered from significant methodological limitations, such as differences in baseline characteristics between treatment groups, small case numbers, and the lack of adjustment for relevant confounders. Overall, medical effectiveness and safety were similar for both surgical approaches. However, there was a trend towards lower recurrence rates, length of hospital stay, and postoperative pain as well as decreased complication rates for the laparoscopic repair in the majority of studies. The impact of the technique of mesh implantation and mesh fixation as well as the impact of certain patien- related factors was not systematically assessed in any of the studies. Conclusion No conclusive differences could be identified between the operative techniques. There was, however, some evidence for a trend towards similar or slightly improved outcomes associated with the laparoscopic procedure. There remains an urgent need for high-quality prospective studies to evaluate this question conclusively.     

Gastric outlet obstruction due to duodenal bezoar: A case report

INTRODUCTIONGastric outlet obstruction (GOO) is a clinical syndrome characterized by abdominal pain and postprandial vomiting. Causes of GOO include both benign and malignant disease. Bezoars, concretions of undigested or partially digested material in the gastrointestinal tract, are a rare entity and GOO due to duodenal bezoar is an uncommon presentation.PRESENTATION OF CASEWe report the case of a 56-year-old woman who presented to the emergency department acutely with a 3-day history of epigastric pain, weakness and postprandial nonbilious vomiting. Initially, an upper gastrointestinal endoscopy (UGE) was performed to evaluate the cause of the GOO. A solid impacted bezoar was detected in the first portion of the duodenum with complete obstruction of the pyloric canal. In spite of multiple attempts for fragmentation using different devices, the extraction attempts failed. We administered acetylcysteine and cola per os. Abdominal computerized tomography was obtained and showed a solid mass in the duodenum. UGE was performed once more however, the mass was not suitable for fragmentation and removal. Thus, surgical treatment was decided. The bezoar was extracted via gastrotomy. The postoperative period was uneventful.DISCUSSIONEven if a duodenal bezoar is small, because of its location it may cause GOO with abruptly clinical features. The diagnostic approach is similar to the other causes of the GOO. However, therapeutic options differ for each patient.CONCLUSIONWe should remember all the therapeutic and diagnostic options for a patient with upper gastrointestinal bezoars who present at the hospital whether or not there is a predisposing risk factor.     

A comparison of single- and multiple-stage approaches to teaching laparoscopic suturing

BACKGROUND: This study assessed the effects of learning laparoscopic knot-tying through a series of progressively more difficult steps versus learning the skill in full complexity. METHODS: Junior residents (N = 24) practiced either (1) suturing in full complexity under 2-dimensional conditions or (2) simple cone transfer drills under 3-dimensional and then 2-dimensional conditions, followed by suturing under 3-dimensional and then 2-dimensional conditions. Pre-, post-, and delayed (1 week) laparoscopic suturing performances were assessed by using objective motion efficiency variables and final product analyses. RESULTS: Both groups showed similar improvements on all measures, which were well retained over the 1-week period (P < .01). CONCLUSIONS: Despite spending less time practicing actual suturing, the group of residents who progressed through the sequence of steps performed as well as those who practiced the entire task in its full complexity, a finding that has implications for minimizing teaching resources and training costs.     

Performance of laparoscopy in identifying malignant ovarian cysts

Background Peroperative identification of malignancy is crucial to management planning for ovarian cysts. The aim of this study was to evaluate the performance of laparoscopy in identifying malignant ovarian cysts. Methods Patients undergoing laparoscopy for ovarian cysts from 1998 to 2001 were enrolled prospectively. Physical findings, Doppler ultrasonography, and serum CA 125 served to compute two risk-of-malignancy indexes (RMI-1 and RMI-2), and laparoscopy findings served to categorize lesions as benign, possibly malignant, or malignant. Frozen sections were examined as needed. Final histology was the reference. Results Of 313 patients, 294 had benign cysts, six borderline lesions, and 13 malignancies. Sensitivity and specificity were respectively 84 and 93% for RMI-1, 92 and 80% for RMI-2, 100 and 99% for laparoscopy, 91 and 100% for frozen sections, and 100 and 100% for laparoscopy plus frozen sections, which had 100% negative predictive value. Six (1.8%) adverse events occurred. Conclusions Laparoscopy reliably identifies ovarian cancer and borderline disease. Morbidity is low compared to oncologic surgery.     

小直径腹主动脉瘤手术治疗和保守治疗疗效的Meta分析

目的:系统评价手术治疗与保守治疗对小直径腹主动脉瘤(AAA)的疗效。方法:检索国内外文献数据库,选择手术治疗(血管腔内修补术和开放手术)与保守治疗小直径AAA的随机对照实验,按照Cochrance系统评价员手册对纳入文献的方法学质量进行评价后,采用Rev Man5.1软件进行Meta分析。结果:共纳入4个随机试验,4篇文献,共计3 314例患者,其中行血管腔内修补术和开放手术1 680例,保守治疗1 634例。Meta分析结果显示,两组之间总原因病死率(SMD=0.97,95%CI=0.68~1.38)、动脉瘤相关病死率(SMD=0.81,95%CI=0.56~1.17)、动脉瘤破裂率(SMD=0.49,95%CI=0.09~2.54,P=0.39)、术后30 d或者住院期间病死率(SMD=0.88,95%CI=0.60~1.291)差异均无统计学意义(均P0.05)。结论:小直径AAA手术治疗与保守治疗疗效相似,但不能确定该结论是否有临床意义,笔者经综合分析认为小直径AAA仍应积极手术治疗。     

A prospective observational study examining quality of life in patients with malignant gastric outlet obstruction

Background

Gastric outlet obstruction (GOO) often complicates advanced malignancy. Palliative options include surgical bypass, endoscopic stent, percutaneous gastrostomy (PEG), or percutaneous jejunostomy (PEJ).

Methods

We enrolled 50 patients with GOO secondary to unresectable primary or metastatic cancer in a study examining palliative interventions. Validated instruments assessed quality of life (QOL) at baseline, 1 month, and 3 months following intervention.

Results

Median overall survival was 64 days. A shorter hospital stay and trend to lower mortality were observed after stent placement; solid food intake and rates of secondary intervention were comparable. Both stent and surgical bypass were associated with acceptable QOL outcomes. Fifteen patients refused participation at 1 month and 28 died of disease before 3 months, so 10 patients completed all surveys.

Conclusions

Although malignant GOO is associated with poor survival, there are reasonable alternatives for palliation. QOL studies are difficult to complete in this population due to severity of illness and short life expectancy.     

Laparoscopic parastomal hernia repair using a keyhole technique results in a high recurrence rate

Introduction  Parastomal herniation is a common complication of stoma formation, and its operative treatment is notoriously difficult. Recently we have reported the promising short-term results of a keyhole technique in which a Gore-Tex Dual Mesh with a central keyhole is laparoscopically fashioned around the bowel to close the hernia. In the long-term, recurrence is one of the major issues in hernia repair, therefore, this aspect was prospectively investigated. Methods  Since 2002, a total of 55 consecutive patients (27 men; median age, 63 years) with a symptomatic primary (n = 45) or recurrent parastomal hernia (n = 10) were electively operated using this technique. Patients were invited to the outpatient clinic on a regular basis and were examined for the occurrence of a recurrent hernia. At the last visit, all patients were asked to complete a short questionnaire. Results  Median follow-up (98%) was 36 (range, 12–72) months. During follow-up a recurrent parastomal hernia was diagnosed in 20 patients (37%). Three recurrences were asymptomatic and were treated conservatively. The other 17 patients (85%) developed mild-to-severe symptoms necessitating redo-surgery in 9 (45%) patients. Surprisingly, satisfaction with the procedure was high among patients (89%), even in the presence of a recurrence. Patients who reported unsatisfactory results belonged mainly to the group in whom the initial laparoscopic approach had to be converted to an open procedure. Conclusions  Based on the results from the present study, which represents one of the largest patient series with the longest follow up available to date, it is concluded that laparoscopic parastomal hernia repair using a keyhole technique has an intolerably high recurrence rate with the currently available meshes. A new mesh with a less pliable central part and without the tendency to shrink is awaited.     

后腹腔镜下无功能肾切除术临床研究(附32例报告)

目的 探讨后腹腔镜无功能肾切除术的可行性及临床效果.方法 分析2006年6月～2010年1月行后腹腔镜无功能肾切除术32例临床资料(其中先天性肾盂输尿管连接部狭窄致肾积水无功能8例,结石梗阻致导致肾积水无功能10例,结核性无功能肾11例,萎缩肾3例).结果 32例均获成功,无中转开放者.本组手术时间80-180min,平均(105±27)min;出血量20～210mL,平均(95±15)mL;术后住院时间5～7天;术中及术后均未输血及发生严重并发症.结论 后腹腔镜下无功能肾切除术具有创伤小,疗效确切,术后恢复快,并发症少等优点,可作为临床单纯肾切除的首选治疗方法.     

A case report of laparoscopic duodenal atresia repair in a neonate using a novel miniature stapling device

IntroductionLaparoscopic duodenal atresia repair is an advanced procedure performed in select pediatric surgical centers. Recently, sub–6 mm endosurgical staplers have been introduced, facilitating and accelerating the creation of intracorporeal intestinal anastomoses.Presentation of caseWe performed a laparoscopic duodenojejunostomy in a one-day-old child with duodenal atresia due to annular pancreas using a novel 5.8 mm articulating endostapler with excellent outcome. The technical details are reported.DiscussionLaparoscopic duodenojejunostomy is a technically demanding procedure due to difficulty in hand-sewn anastomosis in a small and restricted space. With this novel 5.8 mm articulating endostapler, we were able to perform a quicker and easier anastomosis.ConclusionWe report a case of laparoscopic duodenal atresia repair in a neonate using a novel miniature stapling device. This new technique is a safe, quick and easier way to perform laparoscopic duodenal atresia repair.