Laparoscopic Jejunal Atresia Repair - Technique
With Dr. Steve Rothenberg · StayCurrentMD
Part of
Jejunal Atresia 3 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Newborn had prenatal diagnosis of bowel obstruction and was found to have jejunal atresia on upper GI study
Surgeon stands at baby's feet with cameraman on baby's right and scrub tech on patient's left
3-port technique used with 4mm 30-degree scope for visualization and two 3mm ports for dissection
Left mid quadrant port was later changed to 5mm for the stapler
Veress needle is inserted below the umbilicus to avoid injury to umbilical vessels and prevent CO2 embolism
Complete gap identified between proximal jejunum and distal bowel
Visualization of appendix and cecum suggests apple peel defect
Bowel twisting around mesentery confirmed apple peel defect
Because there was no evidence of kink or significant obstruction, mesentery was not further manipulated
Decision made to remove proximal dilated segment to improve bowel motility following surgery because it was relatively short and significantly dilated
3mm bipolar vessel sealer used to take down mesentery by clamping, sealing, and teasing vessels off mesenteric border of bowel
Dissection carried back almost to ligament of Treitz and encompassed approximately 10 cm length of bowel
5mm endoscopic stapler lays down 4 rows of staples and divides between them
Two applications of stapler required because bowel was so dilated with diameter almost 4 cm
Distal jejunal segment anastomosed to proximal dilated segment in end-to-side fashion
Enterotomy made in proximal dilated bowel using 3mm hook cautery and decompressed with 3mm sucker
Distal jejunal segment enterotomy slightly dilated to allow access of stapler
End-to-side anastomosis approximately 2.5 cm in length performed without difficulty
Resultant enterotomy closed with running bioabsorbable suture
Previous to having stapler, would have performed end-to-end anastomosis with multiple interrupted or running sutures
No evidence of significant mesenteric defect or gap in anatomy after enterotomy completion
Procedure took 80 minutes and was tolerated well by infant
Patient had diminishing NG aspirates over next week
Upper GI obtained one week postoperatively showed widely patent anastomosis
Resected specimen measured 10 cm