Simple incision: A safe and definitive procedure for congenital duodenal diaphragm

Abstract Background : Duodenal diaphragms generally are treated by either a duodeno-duodenostomy or excision. The former is a bypass procedure that involves a major anastomosis with its inherent postoperative problems, whereas the latter may result in inadvertent damage to the biliary and pancreatic ducts. To circumvent these problems, the authors used the technique of incision of the diaphragm on its lateral aspect. Methods: Medical records of five children who underwent surgery for a perforate duodenal diaphragm during the period of 1992 through 1994 were reviewed retrospetively. All patients underwent a similar procedure. A longitudinal duodenotomy was made and the diaphragm incised on its anterolateral aspect. The cut edges of the diaphragm were oversewn, and the duodenotomy closed in "Heineke-Mikulicz" fashion. Results : At a follow-up ranging from 1 to 3 years, all patients are growing normally and remain free of any obstructive symptoms. Conclusions : This simplified approach is a safe and physiological way of restoring the duodenal continuity and is associated with a highly satisfactory outcome.