**4.1 Surgical treatment options**

Currently, the standard method of recanalizing the duodenal lumen is a diamond-shaped duodenal anastomosis, first reported by Kimura K. et al. [35]. Reconstruction is usually performed *via* right supraumbilical or umbilical incisions [10, 36–42]. The introduction of minimally invasive laparoscopic instruments, optical systems with small diameters, and high-resolution screens has expanded the potential of laparoscopy. These developments have increased the interest of pediatric surgeons in laparoscopy as a modality for reconstruction in patients with CDO [43]. Procedures considered complicated in the past have become both practical and effective [3, 4, 44, 45].

The first laparoscopic reconstruction for duodenal atresia was performed in 2001 by Bax N. [46]. In 2002, Gluer S. et al. described a case of laparoscopy reconstruction for annular pancreas and malrotation [47]; however, the initial experience of endoscopic duodenal anastomoses was overshadowed by a high number of conversions to

#### *Duodenal Atresia DOI: http://dx.doi.org/10.5772/intechopen.109690*

laparotomy and postoperative anastomotic leakage. Van der Zee D. even announced a temporary moratorium on performing minimally invasive interventions in patients with duodenal atresia due to excessive complications. He restricted the use of laparoscopic duodenal atresia repair to centers with extensive experience in pediatric laparoscopic surgery and intracorporeal suturing [3, 4, 48]. As more experience was gained, the operative technique was refined, and duodenal anastomosis could be performed with acceptable long-term results in this advanced center. Other studies also demonstrated the high efficacy and safety of laparoscopic surgery in the treatment of duodenal atresia [49–51]. Razumovsky A., one of the pioneers of neonatal minimally invasive surgery, has the greatest experience in performing laparoscopic duodenal anastomoses in Russia [52].

Several progressive surgical schools have presented modifications of laparoscopic duodenal anastomoses. Son T. et al. reported a side-to-side duodenal anastomosis [53]. Muensterer O. and Lacher M. showed that duodenojejunal side-to-side anastomosis can be performed to restore the lumen of the duodenum [54].

Laparoscopy allows for faster postoperative recovery and better cosmetic results. This knowledge promotes widespread use of laparoscopy in newborns and infants. However, laparoscopic duodenal anastomosis is considered the most demanding surgical procedure in pediatric surgery [48, 55]. Therefore, this procedure is restricted to be performed in advanced centers specializing in minimally invasive surgery in neonates [48]. Duodenal stenosis is most often located in the second (descending) portion of the duodenum [15]. Historically, such patients were treated surgically with laparotomy or laparoscopy. Despite the results of such treatment being satisfactory, these techniques are fraught with risks associated with the operation itself and general anesthesia, and do not show good cosmetical results [35, 46, 56]. In addition, the risk of adhesive intestinal obstruction in infants after laparotomy is approximately 6–14% [57] and is absent if the peritoneum is left intact, as, for example, with transoral access.
