A novel technique for correction of intestinal atresia at the ligament of Treitz

Purpose: After reconstruction of jejunal atresias at the ligament of Treitz , many patients do not respond to simple tapering and anastomosis requiring repetitive operations because of dysfunction of dilated proximal bowel. A new operative approach using lateral duodenectomy and duodenojejunostomy (L DAD) is reported. Methods: Three infants with atresias within 10 cm of the ligament of Treitz were treated with LDAD, and their records are reviewed retrospectively. Th e entire duodenum is visualized after creating a malrotation; this is follo wed by opening the dilated duodenum and resecting dilated proximal jejunum. The resection is extended proximally, incorporating the lateral duodenal i ncision, excising the lateral duodenal wall, and preserving the ampulla. Th e residual duodenum is fashioned into a tube and anastomosed to the spatula ted distal jejunum. Results: Three infants underwent this procedure over a 4-year period. Two h ad undergone tapering enteroplasties previously but were unable to tolerate oral feedings; 1 infant had LDAD primarily. Ail were ultimately successful ly managed by LDAD and were feeding within 14 days. Follow-up is from 14 to 49 months. Conclusion: Although experience is limited to 3 patients, the prompt return of intestinal function with LDAD may justify primary use of this more radi cal procedure in difficult-to-treat proximal atresias. J Pediatr Surg 35:35 3-356. Copyright (C) 2000 by W.B. Saunders Company.