Development of a Modified Duodenum Traction Technique in Laparoscopic Duodenal Web Excision

Laparoscopic duodenal web resection surgery remains safe in neonates. The pearls in laparoscopic duodenal web excision are a proper and stable duodenal exposure. Herein, we present a modified duodenal traction technique, which can improve operative field exposure in laparoscopic surgery. This modified technique was performed in 54 patients during laparoscopic duodenal web resection surgery at our center. It was performed using a 5-0 PDS-II suture, which was introduced percutaneously at 1-2 cm under either side of the costal margin at the anterior axillary line, respectively, to retract the duodenum. Perioperative data of these patients and short-term follow-up data of duodenal web patients were retrospectively reviewed. All 54 procedures were completed without conversion to open surgery or requiring additional ports. Patients' mean age at surgery was 5 days (range 2-30 days), and the median weight at the time of surgery was 3.25 kg (range 2.52-3.88 kg). Eight patients (14.8%) had complete membranes, whereas 46 (85.2%) had a membrane with a hole. The mean time required for this technique was 336 (range 216-416) seconds and the mean duration of the entire surgery was 77 (range 65-89) minutes. The mean postoperative hospital stay was 16 (range 9-90) days and no postoperative complication related to the suspension procedure occurred. Our outcomes demonstrated the modified duodenal traction technique is a feasible and ideal method during laparoscopic duodenal web resection surgery.