Walk Casey T, Meagher David, Christian Jeffrey, Barnett Sean, Pence Jeffrey, Chaudhary Mirnal, Aranda Arturo
1 Department of Surgery, Wright State University, Miami Valley Hospital Weber Center for Health Education, Dayton, Ohio.
2 Department of Pediatric Surgery, Dayton Children's Hospital, Dayton, Ohio.
J Laparoendosc Adv Surg Tech A. 2019 Apr;29(4):579-581. doi: 10.1089/lap.2018.0524. Epub 2019 Feb 15.
Recently, a 5 mm laparoscopic stapler entered the market and is currently used for a wide variety of pediatric applications. The aim of this article is to be the first report of the use of this 5 mm laparoscopic stapler for open neonatal intestinal anastomosis in humans. We used JustRight (Justright Surgical) 5 mm laparoscopic stapler in 5 patients, with a total of six anastomoses being constructed. Enteroenterostomies after bowel resection were performed in these neonates with diagnoses of closed gastroschisis with ileal atresia, multiple intestinal atresia, ileal atresia, and jejunal atresia. Side-to-side, functional end-to-end, stapled anastomoses were performed in the standard antimesenteric manner. Using 2.5 cm long staple loads, the anastomoses approximated 1.5 cm. Minimal staple line overlap was incurred. Enteral feedings were initiated, and nutritional goals met, on postoperative days 8 and 15.2, respectively (means). Postoperative recovery was uneventful, notably without anastomotic complications of leak or stenosis. No long-term follow-up was done. The 5 mm laparoscopic stapler offers an attractive alternative in open neonatal intestinal anastomosis, particularly in both ease and time of anastomosis. Its more generalized use in neonatal intestinal reconstruction awaits further scientific investigation.
最近，一款5毫米的腹腔镜吻合器进入市场，目前已广泛应用于各种儿科手术。本文旨在首次报道这款5毫米腹腔镜吻合器在新生儿开放性肠道吻合术中的应用。我们对5例患者使用了JustRight（Justright Surgical）5毫米腹腔镜吻合器，共构建了6个吻合口。这些新生儿的诊断包括闭合性腹裂合并回肠闭锁、多发性肠闭锁、回肠闭锁和空肠闭锁，在肠切除术后进行了肠肠吻合术。采用标准的系膜对侧方式进行侧侧、功能性端端吻合。使用2.5厘米长的钉仓，吻合口长度约为1.5厘米。钉合线重叠最小。分别在术后第8天和第15.2天（平均值）开始肠内喂养，并达到营养目标。术后恢复顺利，尤其没有出现吻合口漏或狭窄等并发症。未进行长期随访。5毫米腹腔镜吻合器为新生儿开放性肠道吻合术提供了一种有吸引力的选择，特别是在吻合的简便性和时间方面。其在新生儿肠道重建中的更广泛应用有待进一步的科学研究。
