Son Tran Ngoc, Liem Nguyen Thanh, Kien Hoang Huu
Surgical Department, National Hospital of Pediatrics , Hanoi, Vietnam .
J Laparoendosc Adv Surg Tech A. 2015 Feb;25(2):163-6. doi: 10.1089/lap.2014.0263. Epub 2014 Dec 23.
The aim of this report is to present our technique of laparoscopic simple oblique duodenoduodenostomy (LSOD) and its results in management of congenital duodenal obstruction (CDO) in children.
Medical records of patients with the diagnosis of CDO undergoing LSOD at our center from March 2009 to December 2013 were reviewed. The LSOD used one infra- or transumbilical 5-mm port for the camera and two 3-mm ports for instruments. After mobilization of the distant part of the duodenum, a 5-0 polydioxanone seromuscular suture was placed on the duodenal wall proximal and distal to the obstruction and tacked to the anterior abdominal wall for traction. The lower duodenum was incised longitudinally distal to the traction suture. The upper duodenum incision was placed away from the traction suture and extended downward obliquely. The duodenoduodenostomy was performed as a "simple" anastomosis.
Forty-eight patients were identified with a median age at operation of 11 days. The median weight at operation was 2650 g. Duodenal atresia and annular pancreas were found in 81.2% and 18.8% of patients, respectively. The median operative time was 90 minutes. There was no conversion to open surgery, anastomotic leakage, or stenosis. The median time from the operation to initial oral feeding was 4 days. Of the 48 patients, 97.9% were discharged in good health with a median postoperative hospital stay of 7 days
The LSOD technique is safe and efficacious and can be a viable option in the management of select cases of CDO in children at experienced centers.
本报告旨在介绍我们的腹腔镜单纯斜行十二指肠十二指肠吻合术（LSOD）技术及其在儿童先天性十二指肠梗阻（CDO）治疗中的效果。
回顾了2009年3月至2013年12月在本中心接受LSOD治疗的CDO患者的病历。LSOD使用一个脐下或经脐的5毫米端口用于摄像头，两个3毫米端口用于器械。游离十二指肠远侧部分后，在梗阻近端和远端的十二指肠壁上放置一根5-0聚二氧六环酮浆肌层缝线，并固定在前腹壁用于牵引。在牵引缝线远侧纵向切开下十二指肠。上十二指肠切口远离牵引缝线并向下斜行延伸。十二指肠十二指肠吻合术作为“单纯”吻合进行。
共确定48例患者，手术中位年龄为11天。手术中位体重为2650克。分别在81.2%和18.8%的患者中发现十二指肠闭锁和环状胰腺。中位手术时间为90分钟。无转为开放手术、吻合口漏或狭窄情况。从手术到开始经口喂养的中位时间为4天。48例患者中，97.9%健康出院，术后中位住院时间为7天。
LSOD技术安全有效，在有经验的中心对于部分儿童CDO病例的治疗是一种可行的选择。
