Proximal transverse elliptical duodenoduodenostomy for the treatment of duodenal atresia : A novel technique

Abstract:

Background/purpose: Although duodenal atresia associated with or without annular pancreas is a common cause of congenital intestinal obstruction, the optimal technique of repair remains controversial. The objective of this study was to describe and evaluate the results that can be achieved by using a novel technique (Transverse Elliptical Duodenoduodenostomy).

Materials and methods: 15 neonates ( 9 boys and 6 girls) with duodenal atresia with or without annular pancreas had been operated upon by same author at Al-Azhar University Hospitals Egypt, King Abdul Aziz Specialist Hospital, and King Faisal Medical Complex, Saudi Arabia in the period from December 2002 to December 2020. The technique will be described in detail. All patients were followed up at OPD by the same author, range (2–48) months. Post surgical time to feedings, hospital length of stay, weight gain and Morbidity and mortality, upper gastrointestinal series (UGIS) and postoperative gastric emptying scans were the parameters of the study to evaluate the results.

Results: They were 15 neonates ( 9 boys and 6 girls),Their ages ranged from 2 to 7dayes.7 patients were premature (gestational age< 37 weeks) and two had Down’s syndrome. All patient had associated congenital anomalies including; annular pancreas in 8 cases, congenital heart disease in 12 cases, both esophageal atresia and vestibular anus in one case and renal abnormalities in 4 cases. At initial operation, duodenal atresia was noted in all patients (5 cases had a type I mucosal atresia, 6 had a fibrous cord connecting 2 atretic ends (type 2), and 4 had a complete separation (a gap) between the 2 atretic ends (type 3). Bile flow was observed in the proximal and distal duodenum after duodenotomy in one case. There was no additional sites of obstruction in all cases. The operative time ranged from 20–35 min. No mortalities were reported. On the 5^th postoperative day UGIS showed no evidence of megaduodenum, leakage or obstruction. Gradual oral feeding started on the same day.

Conclusion: Transverse elliptical duodenoduodenostomy is safe and effective. It avoids the postoperative stenosis and obstruction on long term follow up.

Keywords: Duodenal atresia, Elliptical duodenoduodenostomy.

Biography:

Professor Gamal Al-Saied had been graduated from Al-Azhar University with Bachelor’s Degree in Medicine and Surgery with a general grade very good with honor. His rank was the 9 th in the top 10 graduate list of Faculty of Medicine Al-Azhar University Cairo, Egypt. In 1991, He has been completed his Master’s Degree (MSc) in pediatric surgery (1st part, thesis, and 2nd part). Then, he was appointed as a demonstrator of pediatric surgery in 1992, then, an assistant lecturer of pediatric surgery in 1993 at the Pediatric Surgery Department. In 1998, he has been accredited with a Doctorate Degree in Pediatric Surgery (M.D). Then, he was promoted to a lecturer of pediatric surgery at the Pediatric Surgery Department. In 2004, he was promoted to assistant professor of pediatric surgery at Pediatric Surgical department at Al-Azhar University Hospitals. In 2008, he was certified a Fellowship of European Board in Pediatric Surgery (FEBPS), Glasgow, Scotland. In 2009, he was promoted to a full professor of pediatric surgery at Pediatric Surgical department by Al-Azhar University Hospitals. In 2022, he is certified as a Fellowship of American College of Surgeons (FACS) USA. He had two published theses (MSc and M.D) and he supervised many thesis of a Master’s Degree and Doctorate Degree. Also, he has published 37 international researches in international journals of pediatric surgery and one chapter in international text book (CURRENT CONCEPTS OF URETHROPLASTY) Edited by Donkov I. 2011, pp 35-42. He has been invited as an international speaker and chairperson in many international conferences on pediatric surgery. Currently, He is an Editor-in- Chief for two international pediatric surgery journals and editor of thirteen international pediatric surgery journals. He is also reviewer for many international pediatric surgery journals. In 2003, he was the founder and head of pediatric surgery unit at King Abdul Aziz Specialist Hospital Taif, Saudi Arabia. He has a great and long term experience in neonatal and pediatric surgery field (open and laparoscopic). Recently, in the era of COVID-19 and afterwards, he has been invited as an international keynote speaker to many international pediatric surgery webinars.