Laparoscopic Excision of Duodenal Web

  • Ravi P. Kanojia

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The presented video is a case demonstration of laparoscopic excision of duodenal web (DW). This is a condition which is often encountered in pediatric age group and is commonly associated with malrotation. Duodenal web presents as chronic gastric outlet obstruction and child presents with vomiting.

The video is aimed at Pediatric laparoscopic surgeon, Pediatric gastroenterologist General surgeons with pediatric practice. The viewer will be able to see the basic steps of the procedure with methods of handling the dilated duodenum.

Introduction

The presented video is a case demonstration of laparoscopic excision of duodenal web (DW). This is a condition which is often encountered in pediatric age group and is commonly associated with malrotation. Duodenal web presents as chronic gastric outlet obstruction and child presents with vomiting.

About The Author

Ravi P. Kanojia

Dr Ravi P. Kanojia is a Professor of Paediatric surgery and predominantly practices Paediatric Laparoscopy and Robotic surgery. He has more than 15 years of experience in this field and has done several surgical firsts in the area of Paediatric Laparoscopy. He has trained from several reputed institutions and attended major Paediatric Surgery centres worldwide. His basic Paediatric Surgery training is from King George’s Medical University and following that has been a consultant in PGIMER Chandigarh. He has been a fellow of Paediatric surgery and Paediatric urology at Women’s & Children’s Hospital Adelaide Australia and Juntendo University Tokyo Japan. He has several awards and honours to his name in the field of Paediatric Surgery, including EUPSA travel fellow and WOFAPS fellow.

He has more than 70 publications and several academic positions are served by him. The most notable are as the Editorial secretary of Journal of Indian Association of paediatric Surgeons (PubMed Indexed Journal 2008-2013). He is the current Editorial Manager for Journal of Paediatric Endoscopic Surgery. He is also the Honorary Secretary of Indian Association of Paediatric Surgeons, a society which advises the practice of Paediatric Surgery in the Indian subcontinent.

A detailed information is available on www.clickonravi.com.

The author has a passion towards online teaching with his teaching videos on YouTube platform and there are 100+ paediatric laparoscopy videos posted on his YouTube channel with more than 1300 subscribers and more that 250000 views of the channel.

 

About this video

Author(s)
Ravi P. Kanojia
DOI
https://doi.org/10.1007/978-981-15-7021-6
Online ISBN
978-981-15-7021-6
Total duration
13 min
Publisher
Springer, Singapore
Copyright information
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2020

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Video Transcript

[MUSIC PLAYING]

Our subject patient is a six-year-old girl who had a history of surgery of malrotation in the newborn period. She underwent laparoscopic Ladd’s procedure. But in the follow-up, she continued to have off and on vomiting in the follow-up period and, afterwards, upper GI contrast study, which showed a large gastric dilatation, or dilatation of the duodenum. There was passage of contrast behind the duodenum, but it was delayed and was suggestive of duodenal obstruction.

So with that, a working diagnosis of duodenal web was made, and the efforts were made towards this diagnosis. As you can see on this X-ray, you can see that there is a large dilation of stomach with the duodenum. And there is an area which is a suspected web area, which you can see. So with this, we planned this patient for laparoscopic excision, and excision of the duodenal web with duodenal repair.

So with this, you can see that once we have gone inside, this is the stomach. And you can easily appreciate the large, dilated duodenum. This duodenum was severely dilated, almost five to six times of its original diameter. We identified the normal landmarks in this region first. You can see that’s the pylorus. And with the initial steps of identifying, we started mobilizing the duodenum.