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Duodeno-duodenostomy for Duodenal Atresia
Chapter 1 of 4 · Surgical Management
Exposure
Exposure and Initial Findings
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What the experts said
The patient is a two-day-old boy with duodenal atresia.
A transverse right abdominal incision allows access to the duodenum and small intestine.
Malrotation is present in this case.
Duodenal atresia type III is present in this case.
The proximal duodenal opening is made at the most dependent part.
The distal limb is opened on the anterolateral surface to avoid injury to the opening of the common bile and pancreatic ducts.
Bile coming out on opening of the distal limb confirms patency to that point.
The diamond-shaped technique creates two openings with perpendicular axes.
Distal patency is checked by injecting saline and observing its filling to the whole bowel.
The anastomosis technique uses two opposing borders of the diamonds to make the posterior wall and the far-facing borders to make the anterior wall.
The posterior wall is sutured from the inside with full-thickness sutures.
The anterior wall is sutured from the outside.
5-0 absorbable sutures are used for the anastomosis.
Suturing starts with the middle of the posterior wall and advances toward the angles with interrupted sutures.
The angle suture is placed from the outside in an extramucosal fashion.
The anterior wall sutures are placed in an extramucosal fashion starting from the angles and working towards the middle.
The proximal dilated pouch is brought downwards to meet the distal limb during anterior wall closure.
Widening of the root of the mesentery is performed after completing the anastomosis.
The superior mesenteric vessels should be visualized during mesenteric root widening.
The peritoneal covering is carefully dissected to allow adequate widening of the mesenteric root.
Appendectomy is performed as part of the procedure.
The bowel is returned to the abdomen with the colon in the left side and the duodenojejunal junction in a straight direction.