Title : Proximal transverse elliptical duodenoduodenostomy for the treatment of duodenal atresia : A novel technique
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 5th 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.