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Duodenotomy
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Laparoscopic Excision of Duodenal Web
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Once the entire C loop of duodenum was mobilised the distal part of D3 was seen to narrow down in calibre. This transitional duodenal area was suspected to have the web.
Keywords
- C Loop
- Duodenum
Conflict of Interest
The author declares no conflict of interest.
About this video
- Author(s)
- Ravi P. Kanojia
- First online
- 07 August 2020
- DOI
- https://doi.org/10.1007/978-981-15-7021-6_2
- Online ISBN
- 978-981-15-7021-6
- Publisher
- Springer, Singapore
- Copyright information
- © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2020
Video Transcript
As you clear off all the attachments around the dilated duodenum, you start seeing sort of a transition zone where the dilated duodenum is transitioning into a normal area. So at this stage, you can see that since our one hand was constantly holding the dilated duodenum up, and the entire resection was being done with single hand, we decided to do an abdominal wall hitch. It’s a double-loop abdominal wall hitch so as to prevent any kind of biting off because of the hitch. And with this double loop, the entire duodenum was lifted up, and it helped in the further dissection of the duodenum.
So more mobilization was done. And we were intending to mobilize the entire C part of the duodenum, up to the ligament of Treitz. Here you can see that we have started seeing a part of duodenum which is appearing to be normal in caliber. There is some amount of pancreatic fat which has now started showing up. So that’s the normal caliber duodenum, and we are almost at the D3. And that’s the head of the pancreas.
At this stage, we decided to check on the position of the DJ and the small bowel mesentery, as it was a previously known case of maturation. We found that the DJ was on the left side of the midline, in the vertebral column. And the mesentery of the small bowel was fairly wide, so nothing needed to be done in that area.
So you can see that this is the mobilized part which we have mobilized from the other side. And this has started appearing in the DJ area. So we suggested that we have nearly completed our mobilization, and we decided on creating a duodenotomy.