Laparoscopic Excision of an Ileal Duplication with Intracorporeal Enteroenterostomy in an Infant

Abstract

Introduction:

A 6-month-old male underwent laparoscopy for resection of a bowel duplication. He initially presented with 2 days of emesis and had imaging performed that was consistent with an ileal duplication cyst. We present a technique of ileal duplication cyst excision with intracorporeal primary bowel anastomosis.

Methods:

A 5-mm port was placed through the umbilicus and a diagnostic laparoscopy was performed. The duplication cyst was seen in the wall of the distal ileum nearly 20 cm from the terminal ileum. Two additional 5 mm ports were placed in the midline and left flank. The intestine was pexed to the abdominal wall on one side of the cyst to provide adequate observation of the specimen. Two small openings were made in the mesentery on either side of the duplication cyst using hook diathermy. A 5 mm endoscopic stapler was used to divide the proximal and distal bowel. After resecting the cyst, stay sutures were placed on the ends of the remaining bowel and were approximated to one another. Small enterotomies were made into both afferent and efferent ends using hook diathermy, after which the bowel was anastomosed in a side-to-side functional end-to-end manner using a 5 mm endoscopic stapler. Staple lines were reinforced with interrupted 5-0 Vicryl sutures. The 5-0 Vicryl sutures were used to close the mesenteric defect and the specimen was delivered through the umbilical incision. The operative time was 101 minutes.

Results:

The patient tolerated the procedure and had an uncomplicated postoperative course. He was restarted on normal feeds 2 days after surgery. He tolerated his feeds well and was having normal stools. Pathology analysis of the surgical specimen confirmed the lesion to be a full-thickness duplication cyst without additional histologic abnormalities. The patient was seen at regular intervals after the surgery and did not experience recurrence of his original presenting symptoms.

Conclusions:

We display a technique of laparoscopic ileal duplication cyst excision with intracorporeal enteroenterostomy that achieved a desirable outcome in a young child. This surgical technique is a safe and effective method for the definitive treatment of small bowel duplication cysts, and can be considered in patients who are as young as 6 months of age.

No competing financial disclosures exist for all authors involved in the making of this publication.

Runtime of video: 6 mins 24 secs