ABSTRACT
Objective To discuss the feasibility of laparoscopic simple oblique side-to-side duodenoduodenostomy in treating congenital annular pancreas in neonates.Methods Medical records of neonates with the diagnosis of congenital annular pancreas undergoing laparoscopic simple oblique side-to-side duodenoduodenostomy at Huai'an Women and Children's Hospital from January 2015 to May 2017 were reviewed.The age ranged from 1 d to 4d with a median age of 2d at operation.The body weight at operation was 2.5-3.5 kg with a mean of 3.1 kg.By a lower-pressure pneumoperitoneum of 5-8 mmHg (1 mmHg =0.133 kPa) and a suspending suture for liver elevator,the procedure was performed using 4 ports.A transumbilical 5-mm port was for the laparoscopy and 3 3-mm trocars were placed for inserting instruments.The diagnosis was made after laparoscopic exploration,and then the distal duodenum was incised longitudinally 0.5-1 cm away from the annular pancreas,the proximal duodenum was incised O.5 cm away from the annular pancreas obliquely.The duodenoduodenostomy was performed as a "simple oblique" side-to-side anastomosis with 5-0 PDS running suture.Results All the 6 cases were treated by laparoscopic simple oblique side-to-side duodenoduodenostomy.Three of cases were annular pancreas complicated with congenital intestinal malrotation,and Ladd's procedure was accomplished in the mean time.The average operative time was 98 min (70-120 min).The blood loss during operation was 3-10 ml.Fluid diet started on postoperative day 3 to 7 (mean 4.5 d),without abdominal distention and vomit,and all the cases were discharged uneventfully in a median of 7-14 (mean 9 d) postoperative day without any postoperative complications.No cases were transferred to open abdominal surgery,and there were no intraoperative and postoperatuve adverse events.The cases were followed-up for 1-30 months (mean 13 months),and all the cases grew well without intestinal obstruction.Conclusions The laparoscopic simple oblique duodenoduodenostomy in treating congenital annular pancreas was conveniently performed,the intestinal function recovered quickly,which can be safely done in neonatal period even if the neonate was complicated with congenital intestinal malrotation.