ABSTRACT
Objective:To explore the possibility of laparoscopic simple oblique duodenoduodenostomy in the management of congenital duodenal obstruction in neonates.Methods:The clinical data of neonates with congenital duodenal obstruction undergoing laparoscopic simple oblique duodenoduodenostomy at Huaian Women and Children′s Hospital from February 2015 to February 2018 were retrospectively reviewed.By a lower-pressure pneumoperitoneum of 5-8mmHg and a suspending suture for right liver elevator, the procedure was performed using 4 ports: a transumbilical 5-mm port for the camera and another three 3-mm ports for instruments.After kocherizing of the proximal and distant part of the duodenum, the lower duodenum was incised longitudinally 0.5-1cm distal to the blocked end, the upper duodenum incision was placed 0.5cm away from the blocked end extended downward obliquely.The duodenoduodenostomy was performed as a " simple" " oblique" anastomosis with 5-0 PDS suture.Results:Fifteen patients were identified with a median age at operation of 2 days.Of all the cases, 4 cases were duodenal atresia (type Ⅲ), 11 cases were annular pancreas, and 7 cases of them were annular pancreas complicated with congenital intestinal malrotation.All cases were treated with laparoscopic simple oblique duodenoduodenostomy.Ladd procedure was accomplished in 7 cases with congenital intestinal malrotation in the meantime.The average operative time was (115.0±25.5) min (70-145 min). Feedings were started on postoperative 4-10d (mean 6.0d), without abdominal distention and vomit, all patients were discharged in good health with a median postoperative hospital stay of 7-14d(mean 10.6d). There was no mortality rate, no conversion to laparotomy, and no intraopertive complications in the group.The cases were followed-up for 2-36 months (mean 15.6 months), and all cases were doing well.Conclusion:Laparoscopic simple oblique duodenoduodenostomy is safe and efficacious in neonatal period, and can be a viable option in the treatment of neonates with congenital duodenal obstruction.
ABSTRACT
Objective To explore the clinical value of portal exposure in laparoscopic treatment of children with type Ⅲ biliary atresia (BA).Methods From June 2013 to October 2017,30 infants with type Ⅲ BA who treated with laparoscopic portoenterostomy in Huai'an Women and Children's Hospital were selected.A percutaneous suture was used to snare the round ligament and retract the liver,other percutaneous stay sutures were then introduced and fundus and neck of gallbladder were sutured to elevate the liver to expose the portal hepatis.The fibro cord and hepatic vessels were mobilized,and then two rubber bands were put around the left and right portal veins and hepatic arteries.The portal hepatis was exposed by laterally stretching the two elastic rubber bands.The fibro cord was removed and then laparoscopic portoenterostomy was accomplished.In 20 cases,the liver was enlarged,part of hepatic lobus quadratus was removed laparoscopiclly for exposure of the portal hepatis.Results There were 30 cases in this group,2 cases were converted to open surgery by a micro transverse incision.There was no surgical death.Time of laparoscopic procedure varied from 210 to 280 min.All cases survived the surgery without any intraoperative complications.Blood loss during operation was minimal,without necessity for blood transfusion.One case died of respiratory failure one week after surgery.Two cases were lost follow-up.Twenty-five cases were followed up for 3～51 months(mean 22.4 months).Three cases died because of repeated cholangitis and liver failure at 10,16,35 months postoperatively.Nineteen patients' total bilirubin had dropped to normal,three others' bilirubin levels dropped significantly after surgery.Conclusion The technique of laparoscopic hepatic porta exposure can help to complete hepatic portoenterostomy successfully,reduce the conversion rate of laparoscopic surgery,and improve the surgical effect.
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.