ABSTRACT
Gastrojejunostomy without gastric resection is performed to bypass the distal stomach or the duodenum. Gastrojejunal stoma (GJ) obstruction is an unusual complication. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities or intraoperatively, as the classic features are absent during the first 24 h and even for several days. Symptoms of injury to other intra-abdominal organs or structures commonly mask or supersede that of pancreatic injury, both early and late in the course of trauma. Hence, these injuries are often overlooked. We present a case of gastrojejunal stoma obstruction after a primary repair of traumatic American Association for the Surgery of Trauma" (AAST) grade IV duodenal injury. The surgery included repair of the duodenum over a T-tube, a pyloric occlusion, a retrocolic loop gastrojejunostomy, and feeding jejunostomy. And thereafter, successful management of postoperative complication with adhesiolysis, necrosectomy, and revised antecolic isoperistaltic Roux-en-Y gastrojejunostomy for retrocolic GJ stoma obstruction due to post-traumatic pancreatitis.
ABSTRACT
Background: Over the last decade, a significant rise in pediatric robot-assisted minimally invasive surgeries has been observed. Apart from the urological surgeries in children, robot assistance for complex nonurological reconstructions is being explored increasingly. This study highlights our preliminary experience of robot-assisted minimally invasive surgeries in children. Materials and Methods: An ethical waiver was given by the Institute's Ethics Committee in view of the retrospective nature of the study and all procedures being performed as a part of the routine care. A retrospective analysis was done to include all the pediatric robot-assisted surgeries performed at our hospital over a 4-year period (January 2017-January 2021). The surgeries were categorized based on the involved organ system and the total study duration was divided into four 12-month time periods. A comparison of the total number of surgeries done in each time period was also done. A log of the surgeon's console duration for each surgery was also kept. Results: A total of 65 patients, with the majority (50/65; 77%) undergoing reconstructive surgeries for anomalies within the genitourinary system, were included. Almost two-thirds of the total surgeries were technically complex. The number of procedures performed during the four 12-month time periods was 18, 18, 15, and 14. The average (range) surgeon's console time was 95 minutes (45-327 minutes) and showed a progressive improvement with the passage of time. Only 1 patient required conversion to an open approach, and none had major complications during the postoperative period. Conclusion: Our early experience of robot-assisted minimally invasive surgeries in children reaffirms its safety and feasibility in complex reconstructive surgeries. It also highlights the advantages of robot assistance in smaller children with nonurological anomalies.
