Laparoscopic Repair of Duodenal Atresia with Concurrent Situs Anomaly: A Case Series and Technical Considerations

초록

Highlights What are the main findings? Laparoscopic duodenoduodenostomy was successfully completed in all neonates with duodenal atresia and situs anomaly without open conversion, with operative time, feeding milestones, and hospital stay comparable to those with normal situs. All situs anomaly cases presented with situs ambiguus, interrupted inferior vena cava with azygos continuation, and intestinal malrotation, yet none experienced anastomotic complications or reoperations. What are the implications of the main findings? Complex visceral malposition, including heterotaxy syndrome, should not be considered a contraindication to minimally invasive repair; laparoscopic duodenoduodenostomy is feasible and safe with appropriate preoperative imaging and individualized trocar placement. These findings expand the applicability of minimally invasive neonatal surgery to anatomically challenging patients, supporting its adoption in high-volume centers managing duodenal atresia with concurrent laterality defects.Highlights What are the main findings? Laparoscopic duodenoduodenostomy was successfully completed in all neonates with duodenal atresia and situs anomaly without open conversion, with operative time, feeding milestones, and hospital stay comparable to those with normal situs. All situs anomaly cases presented with situs ambiguus, interrupted inferior vena cava with azygos continuation, and intestinal malrotation, yet none experienced anastomotic complications or reoperations. What are the implications of the main findings? Complex visceral malposition, including heterotaxy syndrome, should not be considered a contraindication to minimally invasive repair; laparoscopic duodenoduodenostomy is feasible and safe with appropriate preoperative imaging and individualized trocar placement. These findings expand the applicability of minimally invasive neonatal surgery to anatomically challenging patients, supporting its adoption in high-volume centers managing duodenal atresia with concurrent laterality defects.Abstract Background: Laparoscopic duodenoduodenostomy is an established approach for duodenal atresia, yet its applicability in neonates with concurrent situs anomalies remains poorly defined. This study evaluated the feasibility and perioperative outcomes of laparoscopic duodenoduodenostomy in this population. Methods: A retrospective review was conducted of all neonates who underwent laparoscopic repair for duodenal atresia by a single surgeon at Samsung Medical Center between January 2017 and December 2023. Thirteen patients were divided into situs anomaly (n = 3) and situs solitus (n = 10) groups. Anatomical features, operative details, and perioperative outcomes were reviewed and descriptively summarized according to situs status. Results: All three neonates in the situs anomaly group had situs ambiguus-left isomerism with polysplenia (n = 2) or right isomerism with asplenia (n = 1). Interrupted inferior vena cava with azygos continuation and intestinal malrotation were present in all three patients; however, only two required a concurrent Ladd procedure. Laparoscopic repair was completed in all 13 patients without open conversion. Operative time, feeding milestones, and hospital stay were descriptively similar between groups. No anastomotic complications, reoperations, or mortality occurred. Conclusion: In this small case series, laparoscopic duodenoduodenostomy was completed without conversion or perioperative anastomotic complications in neonates with duodenal atresia and concurrent situs anomalies. Situs anomaly alone may not preclude minimally invasive repair in experienced hands.

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