Laparoscopic methods in the treatment of congenital duodenal obstruction for neonates.

OBJECTIVE: To evaluate the feasibility of and indication for laparoscopic methods for neonates with congenital duodenal obstruction.

PATIENTS AND METHODS: From September 2009 to October 2012, 40 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 6-8 mm Hg and a suspending suture for the right liver elevator, the procedure was performed using four trocars 3-5 mm in diameter. Under laparoscopic vision, the causes of duodenal obstruction were diagnosed, and then the operation methods were determined by the type of obstruction.

RESULTS: Of the 40 cases, 4 were duodenal atresia (type II), 8 were duodenal stenosis, 8 were annular pancreas, and 20 were congenital intestinal malrotation. For the cases with duodenal diaphragmatic stenosis a partial excision of the diaphragm was performed after longitudinal incision of the anterior part of the duodenum followed laparoscopically by a transverse suture. For the cases with duodenal atresia (type II) and annular pancreas, a duodenal diamond anastomosis was successfully carried out through a laparoscopic approach. Ladd's operational method was performed in the cases with congenital intestinal malrotation. Feedings were started on postoperative Day 3-7, without abdominal distention and vomiting, and discharge from the the hospital was on postoperative Day 9-14.

CONCLUSIONS: Congenital duodenal obstruction is a common malformation in neonates. The laparoscopic procedure is an important method of diagnosing, and correct operational methods are the key to improve the therapeutic effect in the treatment of congenital duodenal obstruction. The laparoscope has the value of a small incision, microinvasion, and better recovery in diagnosis and treatment for congenital duodenal obstruction. The laparoscopic methods can be performed in neonates safely and are appropriate for a full-term newborn with tolerance to CO2 pneumoperitoneum.