Kozlov Y, Novogilov V, Yurkov P, Podkamenev A, Weber I, Sirkin N
Pediatric Hospital, Newborn Surgery, Irkutsk, Russian Federation.
Eur J Pediatr Surg. 2011 Mar;21(2):124-7. doi: 10.1055/s-0030-1268455. Epub 2010 Dec 14.
We report on our experience of repair of congenital duodenal obstruction using a circumumbilical incision. The aim of this report is to describe how a Bianchi approach provides a safe and invisible alternative to transverse abdominal incision for the repair of duodenal atresia.
Between January 2005 and December 2009, we treated 13 cases with congenital duodenal obstruction using a circumumbilical incision (Group I) and 14 cases with this condition repaired using a standard transverse right upper abdominal incision (Group II). Surgical procedures included a diamond-shaped duodenoduodenostomy as originally described by Kimura and standard duodenal web excision. The circumumbilical incision utilized at our institution is a classic Bianchi procedure. The 2 groups were compared with regard to patient demographics, operative reports and postoperative outcomes.
There were no differences in preoperative parameters such as gestational age, age at surgery, or body weight at operation between the 2 groups. The circumumbilical cohort and transverse incision cohort had similar rates of congenital anomalies (61.54% vs. 64.29%), Kimura diamond-shaped anastomosis (61.54% vs. 64.29%) with only a slight female predominance in Group I. The mean operating time in Group I was 65.0 min while mean duration of the operation in Group II was 64.64 min. The difference between groups was statistically not significant (p>0.05). The mean time to full enteral feeding for patients with an umbilical incision was significantly shorter (p<0.0001) compared to patients with a standard incision (6.92 days vs. 11.86 days). Mean postoperative hospital stay was longer for patients in Group II (19.71 days vs. 12.38 days; p<0.0001). The postoperative course was uneventful for all patients. There were no intra- or postoperative complications.
We report on a first series comparing umbilical and transverse right upper abdominal incision for the treatment of congenital duodenal obstruction. Our results suggest that an umbilical incision offers all the benefits of a minimal access approach, including earlier feeding and shorter times to discharge. We consider our approach an intermediate step, with laparoscopy likely to become the "gold standard" for the treatment of congenital duodenal obstruction.
我们报告了使用脐周切口修复先天性十二指肠梗阻的经验。本报告的目的是描述比安基方法如何为十二指肠闭锁的修复提供一种安全且不留明显瘢痕的替代横腹切口的方法。
2005年1月至2009年12月期间，我们使用脐周切口治疗了13例先天性十二指肠梗阻患者（I组），并使用标准右上腹横切口修复了14例此类患者（II组）。手术操作包括木村最初描述的菱形十二指肠十二指肠吻合术和标准十二指肠蹼切除术。我们机构使用的脐周切口是经典的比安基手术。对两组患者的人口统计学数据、手术报告和术后结果进行了比较。
两组患者术前参数如孕周、手术年龄或手术时体重等无差异。脐周组和横切口组先天性异常发生率相似（61.54%对64.29%），木村菱形吻合术发生率相似（61.54%对64.29%），I组女性略占优势。I组平均手术时间为65.0分钟，II组平均手术时长为64.64分钟。两组间差异无统计学意义（p>0.05）。与标准切口患者相比，脐部切口患者完全肠内喂养的平均时间显著缩短（p<0.0001）（6.92天对11.86天）。II组患者术后平均住院时间更长（19.71天对12.38天；p<0.0001）。所有患者术后病程均平稳。无术中或术后并发症。
我们报告了首个比较脐部和右上腹横切口治疗先天性十二指肠梗阻的系列研究。我们的结果表明，脐部切口具有微创方法的所有优点，包括更早开始喂养和更短的出院时间。我们认为我们的方法是一个中间步骤，腹腔镜手术可能会成为先天性十二指肠梗阻治疗的“金标准”。
