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Laparoscopic Management of Small Intestinal Atresia

Laparoscopic Management of Small Intestinal Atresia. George W. Holcomb, III, M.D., MBA Children’s Mercy Hospital Kansas City, MO. Duodenal Atresia/Stenosis. Most common site neonatal intestinal obstruction Associated with Trisomy 21 and annular pancreas Error in re-cannalization

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Laparoscopic Management of Small Intestinal Atresia

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  1. Laparoscopic Management of Small Intestinal Atresia George W. Holcomb, III, M.D., MBA Children’s Mercy Hospital Kansas City, MO

  2. Duodenal Atresia/Stenosis • Most common site neonatal intestinal obstruction • Associated with Trisomy 21 and annular pancreas • Error in re-cannalization • 50% will have another organ system anomaly

  3. Duodenal Atresia/Stenosis • Type 1 – 92% • intact mesentery; web b/w 2 segments • obstruction usually near ampulla

  4. Duodenal Atresia/Stenosis • Diamond-shaped duodenoduodenostomy is the preferred technique

  5. Laparoscopic Approach • Baby supine, foot of bed • Suture around falciform • Liver retraction • Umbilical port – telescope/camera • Working ports right side of abdomen

  6. Laparoscopic Approach Use regular cautery with fine tip needle

  7. Laparoscopic Approach U-clips (Medtronic) used for anastomosis

  8. Laparoscopic Approach

  9. Laparoscopic Duodenoduodenostomy

  10. Concurrent Series2003 - 2006 • Retrospective study • 28 babies – 14 open, 14 laparoscopic • Open: 11 atresia, 3 stenoses • Laparoscopic: 12 atresia, 2 stenoses • No difference in age, weight, chromosomal anomalies, incidence of heart disease b/w 2 groups AAP, 2007

  11. Concurrent Series2003 - 2006 AAP, 2007

  12. Conclusions • Laparoscopic approach for duodenal atresia is safe and efficacious • Patients undergoing the laparoscopic approach had more rapid advancement of feedings and shorter hospitalization • Use of the U-clips allows for a faster operation if an interrupted suture technique is preferred

  13. Jejunoileal Atresia • Due to late intrauterine mesenteric vascular accidents • More common than duodenal atresia (1/1000 live births) • Uncommon to have other anomalies

  14. Jejunoileal Atresia • Diagnosis usually evident • More distal the obstruction, more distended loops of bowel • Contrast enema usually helpful

  15. Minimally Invasive Management • Umbilical incision • Extend if necessary • Exteriorize bowel

  16. Minimally Invasive Management • Extracorporeal anastomosis • RLQ or RUQ incision, if necessary

  17. ? ? Questions ? ? www.cmhcenterforminimallyinvasivesurgery.com

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