Laparoscopic duodenoduodenostomy for duodenal obstruction in infants and children

Background/Purpose: Duodenal obstruction, such as that resulting from atresia or web, routinely has been corrected by laparotomy and duodenoduodenostomy. Until recently, no one has reported on the use of minimally invasive techniques to correct this congenital anomaly. Over the last 6 months we have approached 4 patients, 3 with atresia and one with a web, laparoscopically. Three were newborns, and one was 8 months old. Methods: All procedures were performed with 3-mm instruments and scopes. Results: Operating time in all cases was less then 90 minutes. Visualization was excellent, and there were no intraoperative complications. Feedings were started on postoperative day 5 in all 3 neonates and day 3 in the infant. All 4 were on full feedings after 3 days. Follow-up upper gastrointestinal tests show no evidence of stricture or obstruction. Conclusion: Laparoscopy provides an excellent way to evaluate and treat congenital duodenal obstruction. J Pediatr Surg 37:1088-1089.